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Chairperson and Members, thank you for the invitation to attend today’s meeting
and make an opening statement.
So far this year we are meeting, and in many instances exceeding, our Service
Plan targets.
Between inpatient and day cases we are ahead of target by 24,500 (3%)
patients. We have seen 30,000 (6%) more new patients in our Outpatient clinics
so far this year compared with the same period last year. Overall we have seen
80,000 (3.8%) more patients in Outpatient clinics than we had planned to see.
Year on year the number people waiting over 6 months for inpatient care is down
by 15.5% and 38% for day case care.
Last week there was some media comment on cancellations during the first six
months of this year. I would like to put these figures in perspective.
The figures show that there were almost 9,000 inpatient and day case
cancellations. This sounds high in isolation but amounts to around 1.4% of total
inpatient and day case activity during the period. While I appreciate that
cancellations can be distressing for patients, the health service must adapt swiftly
and put emergencies first. Against this backdrop it is a tribute to staff across the
country that cancellations rates are relatively low.
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Regarding Primary Care Teams, at the end of August, 127 teams were holding
clinical team meetings. This is 60% of our target for 2009 which is to have 210
teams holding clinical team meetings by the end of the year.
In relation to staffing we are operating slightly below the allocated ceiling and
absenteeism rates are coming down. At the start of this year absenteeism was at
5.96%. At the end of July it came down to 4.96%. Our absenteeism target is
3.5%.
As indicated to the Committee last March, there are a number of issues emerging
that are putting pressure on our budget. For example more people are now
eligible for medical cards. At the end of August 14,288 more medical cards than
planned had been issued. This upward trend is likely to continue.
The report points out that the Irish health service has been steadily climbing up
the ranks and noted that, and I quote, "the creation of the Health Service
Executive was obviously a much-needed reform".
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Corporate Plan Performance
On a related subject, we have recently completed an analysis of our performance
in relation to the HSE’s three year Corporate Plan’s objectives. The plan sets out
what we are seeking to achieve by 2011.
We are performing well in the level and speed of reduction in MRSA levels,
childhood vaccination which is reaching 95% and the establishment of child and
adolescent mental health teams.
Areas that need focused attention include breast-feeding and caesarean section
rates, disability assessment rates against regulations and emergency department
experiences in selected hospitals.
This is the first time we have carried out such a detailed analysis and, in line with
our total focus on performance measurement; it will be repeated every six
months.
H1N1
The H1N1 pandemic continues to pose a challenge to the population and the
health service.
The rate of influenza-like illnesses has risen from approximately 45 per 100,000
to 76 per 100,000 following the opening of schools. This increase was anticipated
and we expect this figure to plateau over the next few weeks.
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It is important to note that the vast majority of cases are relatively mild and in
most situations people can look after themselves at home and return to normal
activity within 7 days.
Plans are advanced for a mass vaccination programme to begin in early 2010.
Prior to this programme beginning, the Expert Group has advised that those at
higher risk should be vaccinated first, followed by health care workers and
children. This will begin later this month.
GPs have played a very important role in dealing with the pandemic to date and,
as they have the best record of who in the community is considered at higher
risk, they have been invited to participate in vaccinating the higher risk group.
Integrated services
This week we introduced two important initiatives that will, over time, deliver
many tangible benefits to patients and clients and indeed health care staff.
This means Regional Directors will be fully responsible for all service delivery
and reconfiguration in their areas. This will simplify our management processes
and enable strong local responsibility coupled with national consistency.
The second initiative involves bringing together the National Hospitals Office and
the PCCC directorate into one single unit - the Integrated Services Directorate.
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This unit will hold the regional teams to account by monitoring and measuring
their performance against agreed targets in accordance with our Service Plan.
These are not changes for the sake of change. They will make it easier for staff
to form effective teams unencumbered by whether somebody works in a hospital
or in the community. They will enable us to forge stronger connections between
our services such as acute hospital, long stay care, GP, mental health, child
care, emergency, rehabilitation, social work services and so on.
Most importantly they will make it easier for patients and clients to get access to
all the health and social care they need without delay or inconvenience.
Paediatric Services
In relation to acute paediatric services, I would like to advise the Committee that
we are establishing a team to be headed by John O’Brien (CEO of St James’
Hospital on secondment to the HSE) to manage the relationships between the
HSE and the acute paediatrics community.
The team’s focus will centre, in particular, on the three paediatric hospitals in
Dublin in the context of ensuring that the total resource deployed is used to
maximum effect and assuring their preparedness for the move to the new
Children’s Hospital in 2014.
The team will also manage the HSE’s relationships with the National Paediatric
Hospital Development Board and ultimately, acute paediatric services in
hospitals outside Dublin and in primary and community care. The team will begin
its work over the coming months.
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This is a very positive step forward for paediatric care in Ireland. I am conscious
that there has been a degree of uncertainty among staff at the hospital. They
have had genuine apprehensions about the model of care to be provided in the
new paediatric hospital. While there will never be a perfect plan for such a
development, the full participation by Our Lady’s Children’s Hospital will ensure
that the best possible decisions are made as we go forward. It will add greatly to
the overall project which I believe will deliver a paediatric service to the country
that will be admired across the world.
Now that we have arrived at this important point, where all three hospitals are
sharing a common purpose, I believe it is an opportune time for these hospitals,
Temple Street, Our Lady’s Children’s Hospital and the National Children’s
Hospital in Tallaght to actively move towards coming together under a single
governance structure. The benefits of such an arrangement would I believe not
only deliver many better service to children and their families and indeed staff,
but also pave the way for a smooth and more effective transition to the new
paediatric hospital.
I would encourage the Boards of the hospitals to move in this direction and I am
happy to pledge the HSE’s support to such a development.
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Project for the Future Development of Acute Hospital Services
South East Hospital Group
The HSE future strategies for health service delivery are now proceeding to implementation
through the Transformation Programme. The aim is to substantially align Irish health
services with recognised international best practice.
The HSE is now seeking the implementation of these strategies across the South East.
A steering group was established in April 2009 to lead the project to plan and implement the
acute hospital transformation programme in the South East. The title of the project is
“Future Development of Acute Hospital Services”.
Members
x Dr. G. Courtney, Clinical Director, St. Luke’s Kilkenny
x Dr. C. Quigley, Clinical Director, Wexford General Hospital
x Dr. A. Majeed, Clinical Director, South Tipperary General Hospital
x Dr. R. Landers, Clinical Director, Waterford Regional Hospital
x Dr. O. O’Reilly, Director Public Health.
x Mr. M. Doyle, ED Consultant Waterford Regional Hospital
The Steering Group is now considering broadening the membership to include a General
Practitioner, Nurse Manager and an Allied Health Professional.
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Regional Specialty Advisory Groups
In the process of defining and planning the future Organisation of services the Steering
Group has established three Regional Specialty Advisory Groups to provide specific advice
and information on individual services.
This advice / information will advise the strategic plan to be completed by the end of 2009.
The following Specialty Advisory Groups chaired by Hospital General Managers have been
established:
1. General Medicine
2. General Surgery
3. Women and Children’s Health
On completion of the planning phase a “Project Operational and Quality Assurance Group”
will be established to plan and implement the operational aspects of the project. This group
will be supported by operational subgroups dealing with issues such as resource deployment,
employee relations, ICT, logistical planning etc.
Project Structure
Steering Group
Acute Service Development
Operational Subgroups
Resource Deployment, Communications,
Employee Relations, ICT, Transport,
Capital Projects, Logistical Planning.
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All hospitals in the South Eastern Hospital Group - consisting of Wexford General Hospital,
Waterford Regional Hospital, South Tipperary General Hospital, and St Luke’s Hospital
Kilkenny - will be included in the plan for the revised model of care.
In this regard, no decisions regarding the roles of services of any hospitals will be taken until
this plan is completed through a process of broad based consultation within the services. It
is likely to be the end of 2009 before this review is completed. The review will be published
in the first quarter of 2010.
Progress to Date:
The Steering Group has met monthly since April 2009. The Specialty Advisory Groups in
General Surgery, General Medicine and Women and Children’s Health have been established
and meetings are ongoing. The Steering Group has posed a series of questions to each
Specialty Advisory Group to obtain advice on the best model for the future provision of
acute hospital services in the South East.
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Examples of the questions posed include:
The Specialty Advisory Groups are working to deadlines for the completion of reports in
time for meetings with the Steering Group scheduled from18th September to 16th October
2009. These meetings will inform the Steering Group decisions. A full “summit” meeting of
all the project groups will be held on 30th October to discuss interdependent issues.
The Steering Group will then meet at 3 separate decision making forums to finalise decisions
and to commence writing of the final report. These meetings are scheduled from 13th
November to 27th November. Writing of the final report will commence in early December
2009.
Communication
Communication has been an integral part of the project to date. A communication strategy is
in operation, this has been discussed with Corporate Communications. Briefings have been
held with Hospital Department Heads, Oireachtas Members, Forum Members and Medical
Boards. A number of additional meetings are scheduled in September and October with
General Practitioners, PCCC Management, Patient Representative Groups, Oireachtas
Members and Staff Representative Bodies. These meetings take the format of presentation
and interactive discussion.
_________________________
Ms. Ann Doherty,
National Director,
National Hospitals Office.
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Briefing for CEO
Re: H1N1, Pandemic 2009
x The GSK vaccine is now licensed and it is expected that Baxter vaccine will
receive a licence this week.
x We will commence with those in clinically at risk groups under the age of 65yrs.
x Our preferred means of delivering this vaccine to such people is through General
Practice.
x We wrote on 1/10/09, inviting GPs to participate at the fixed fee of €10 per dose.
x On the basis of the delivery of 111,000 doses of GSK vaccine during the week
beginning 5th October, we will distribute vaccine to participating GP sites so that
vaccination can begin during the week commencing 19th October.
x In the event that GPs do not participate, we will commence vaccination during
that same week in HSE mass vaccination clinics.
x Once we become clear about uptake rates during that 4 week period we will be in
a position to begin to commence vaccination for healthcare workers in
occupational settings. We will distribute vaccines for healthcare workers for about
4 weeks and review the need for further distribution based on response rates,
requirements for 2 doses etc as we go along.
x In the event that vaccination of young (under 65) clinically at risk groups through
General Practice does go ahead the HSE will be ready to commence mass
vaccination clinics late in November. The order in which groups will be
vaccinated will be determined by NPHET with expert advice.
x Once the initial two priority groups are vaccinated the vaccine will be offered to
those under 18 (primarily in schools), those over 65 and then the rest of the
population. The order in which these groups will be vaccinated will be determined
by NPHET with expert advice. This phase should start in December 2009.
Item 5 (i) 7.10.09 (JCHC) Louth/Meath Hospital Group
Service Reconfiguration in Louth Meath
Senior HSE management have briefed staff on the 3rd and 4th of September at Louth
County Hospital, Our Lady’s Hospital Navan and Our Lady of Lourdes Hospital along
with union and staff representative bodies on the intended changes required in order to
safely centralise all acute medicine within Louth Hospitals including:
{ opening of the new and expanded Emergency Department at OLOL,
{ the establishment of a Medical Assessment Unit at OLOL ,
{ Reducing average length of stay and improving discharge planning,
{ Provision of home care packages,
{ Reconfiguration of acute beds to rehabilitation and step down beds in LCH
{ Opening of two new inpatient wards over the new ED
{ Development of an observation ward and short stay ward
{ Increasing ICU and CCU capacity ,
{ Conversion of the ED in Louth County Hospital to a 12 hour service,
{ On the transfer of acute medicine to OLOL (mid 2010), the 12hour ED will
convert to a Minor Injuries Unit.
{ Centalising relevant day medical and surgical procedures,
{ Increasing access to diagnostics for GP’s,
{ Enhancing ambulances services.
{ Transfer of ambulance borne trauma from Navan to OLOL when the new
ED opens
x A proposed date for the transfer of acute medical care from the Louth County
Hospital has not yet been determined and will be subject to a number of services
being in place, but will occur in a phased basis,
x Phase 1: now to end 2009:- will see the opening of the new ED, establishment of
the Medical Assessment Unit at OLOL, development of short stay and observation
wards at OLOL, enhancement of medical services and transfer of ambulance borne
trauma from Navan to OLOL.
x Phase 2: end 2009 until mid 2010:- will see new inpatient accommodation, the
increased ICU and CCU capacity and the development of an enhanced ambulance
service. Continued development of non-acute services.
x The HSE now expects that these developments will be put in place over the next
few months which will determine the final transfer date. This will remain under
review and the transfer will be announced once these key elements are in place and
working satisfactorily.
x Louth County Hospital will continue to play a valuable role in the provision of
health services to the people of the North East. This includes day surgery services,
day medical services, outpatient services and minor injury services.
x The existing Medical Wards at Louth County Hospital will in the future provide
rehabilitation and step down services. There will be a 11 bed dedicated Stroke Unit,
in addition to general rehabilitation and beds for step down care.
A Louth Meath Transformation Steering Group has been established under the Chair of
Mr. Des O’Flynn Group General Manager, Ms Eileen Whelan( Director of Nursing and
Midwifery is Project Director and Ms Catriona Crowley Asst Director of Nursing is
Project Manager, and it is expected that the steps above can be completed by Mid 2010.
Members of the Steering Group include Consultants working in Critical Care,
Emergency Medicine, and General Medicine and Geriatrics, Directors of Nursing and
representatives from PCCC and the Ambulance service. The Steering group will now
establishing a number of project groups to oversee the implementation of the various
service developments.
Despite the challenges of keeping clinicians, managers and staff on board we have
managed to maintain momentum as we have moved in phases from:
Our Plan is to build on the momentum achieved in transferring services from Monaghan
in July and to utilise the remaining resources freed up from that change to provide a
“risk” dividend across the region in terms of further progressing the resolution of long
standing risk issues well flagged in many reports over the years including:
x Tackling remaining issues from Lourdes Inquiry Report.
x Bringing midwifery staffing levels up to recognised standards.
x Strengthening staffing levels in Neonatal Intensive Care.
x Ensuring a minimum of one paediatric trained nurse on each shift in Cavan and
Drogheda Emergency Departments.
We will also use this initial freed up resource to kick start the transformation of services
in Louth / Meath.
It is also the case that innovation and demographic funding has been secured to support
the transformation in the North East. Specifically within demographic funding there is
capacity for a number of posts that are essential to ensure the transfer of services from
Louth County Hospital to Drogheda Hospital takes place by mid-2010 which dovetails
with the date that training in medicine for NCHD’s will no longer be accredited by the
RCPI.
Conclusion
This is a major and very complex change process that we have no option but to complete
if we are to address the many issues that have existed particularly within hospital care
within the North East for many years.
It will have significant benefits in terms of the safety and quality of the services that we
provide for patients.
The major project risk we are currently facing is how best to deal with the complexities
of the staff process in the context of the very necessary moratorium on public service
staffing numbers. For these front line services, and despite the fact that we are
significantly below (170WTE) the March 2009 staffing level within Dublin North East
Hospitals overall, it is proving very difficulty to put in place the necessary staff to make
the changes viable.
It is likely that unless this is resolved quickly major milestones within the Louth / Meath
project as well as the overall “risk dividend” for the region will slip significantly.
Item 5 (iv) 7.10.09 (JCHC) – Proposed New Paediatric Hospital
1. Background
The National Paediatric Hospital Development Board (NPHDB) was established in
May 2007 to plan, design, build, furnish and equip the new national children’s
hospital. This will involve the transfer of services from the three existing Dublin
children’s hospitals currently based at Crumlin, Temple Street and Tallaght. The new
children’s hospital will play a central role in an integrated network of paedaitric
services across Ireland. This development will fundamentally change and improve the
provision of paediatric healthcare in Ireland because merging the three existing
hospitals into a single hospital structure will ensure a critical mass of specialised skills
to provide highly complex treatment and care to sick children. The new children’s
hospital will be co-located on Eccles Street with the Mater Misericordiae University
Hospital, which will provide additional benefits for sub-specialisation and the
development of campus-wide support services. The project is progressing in
accordance with the project plan and is due for completion in 2014.
Our Lady’s Children’s Hospital, Crumlin has not yet taken up the Minister’s
invitation to appoint a member to the Board, but is participating on the Board’s sub-
group on the National Model of Care for Paediatric Healthcare Services in Ireland.
There remains an open invitation to Crumlin to nominate a representative to the
NPHDB.
3. Management Team
In discharging its functions, the Board has appointed a Chief Executive, Eilísh
Hardiman (formerly Deputy CEO, St James’s Hospital), Medical Director, Dr Emma
Curtis from NCH, Tallaght and Jim Farragher, Finance Officer. This executive will,
together with any other support staff appointed by the Board, represent the
management team. The Board will discharge its functions through this management
team and through the external consultants and contractors appointed under public
tendering arrangements.
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direction for how and where services are provided to meet the future healthcare
needs of children and young people in Ireland.
5. Developments
1. Headquarters for the NPHDB have been established in 2/3 Parnell Square
East, which is also the office of the HSE Estates Directorate.
2. The designated site for the new children’s hospital at the Mater Campus has
been transferred to the HSE.
3. Active collaboration with the Mater Adult Hospital has commenced with
progress being made to optimise the potential for appropriate sharing of
services across the hospitals on the Mater Campus. Progress is also being
made on the required decanting of the ceded site.
4. The Business Case for the new children’s hospital has been signed off by the
Development Board and a process is in place to engage with the NDFA on the
project.
5. The Design Brief is being prepared and will be presented to the Integrated
Design Team on their appointment in October 2009.
6. Dr Emma Curtis has been liaising with the clinicians from both inside and
outside of Dublin and the professional bodies to inform the brief. A significant
number of clinicians across the three children’s hospitals have already
contributed to the development of the design brief.
7. Discussions have commenced with management at AMNCH to cede a suitable
site for the Ambulatory & Urgent Care Centre at Tallaght.
8. ICT strategy developed for the Children’s Hospital of Ireland and ICT
Programme in progress to meet the hospital’s remit for its role in an integrated
network of paediatric services in Ireland
9. Engagement with the RPA to develop an Eccles Street entrance to the Metro
North – Mater Stop is continuing. This entrance will directly support access to
the new children’s hospital and appropriately meet expected demands on
public transport to service this facility.
10. Arrangements are begin progressed to hold 2 consultation days with children
and young people in December 2009, to seek their opinions and views on
designing the new children’s hospital.
The Business Service Team is charged with providing the following services and
supports:
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Lead the procurement of all services, supplies and works necessary to
deliver an operational class-leading national tertiary children’s hospital,
Provide all project support services from a client perspective,
Advise on all clinical planning matters
Medical Planning, including forecasting health-care trends, methodologies
and medical technology development,
Nurse planning,
Flexibility and future expansion provisions,
Prepare the Preliminary Project Brief and the Definitive Project Brief,
Mandatory consultation with the National Development Finance Authority
as to the most appropriate means of funding the procurement of the new
children’s hospital,
Provide workforce planning,
Establish facilities management structure and contracts,
Manage the operational commissioning process,
Procure and manage training for all staff (front-line, support, technical
etc.) in the operation of the completed facility,
Develop and oversee the execution (by others) of validation procedures,
Provide data for audit and attend any meeting required by auditors and, if
necessary attend and participate in, audit hearings such as the Public
Accounts Committee
7. Project Management
The Board is the process of finalising the contract for the appointed Project
Management Service Team.
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Contractual and non-contractual claims: claims avoidance, anticipation and
management
Ensuring compliance with all statutory matters and in particular the Client’s statutory
Health and Safety requirements,
Dispute resolution within Integrated Project Team
Managing Client instructions/Changes,
Validating payments
Validating insurance cover,
Assisting the Design Consultancy service in the technical aspects of the procurement
of building contractors
Advising the Client on the need to engage specialists (e.g. Planning Consultants,
Landscape architects, Traffic consultants, Consultants to prepare Environmental
Impact Statements)
Recruiting (in accordance with public procurement law, national guidelines and
regulations) specialists,
Ensuring with the Design Consultancy service that the project objectives (design,
function, quality, cost etc.) are achieved
Value management,
Risk Management,
Managing change, variations etc.,
Establishing, monitoring and updating the project execution plan,
Monitoring and managing project execution slippage,
Managing technical aspects of equipment procurement, (the specification and
quantities for equipment shall be prepared by the Client/ Client Business Service
Provider).
Establishing and managing User Groups including administrative and secretarial
support
Managing technical commissioning,
Managing direct contracts including technical aspects of procurement,
Managing all construction and equipping related contracts,
Monthly project reports (Quality, time, cost) to the Client,
Examining and approving the construction final account
Executing Project closure and preparing and distributing the Project Closure
report
Executing the Post Project Review
Prepare and submit final Post Project Review report,
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The Integrated Design Team will provide the following services:
The completed design of demolition, enabling including temporary works, piling
and diversion works in order to clear and prepare the sites for the Children’s
Hospital of Ireland, Eccles St, Dublin and the Ambulatory and Urgent Care
Centre, Tallaght. This will include tendering of the works, preparation of
production information and construction support during completion of the works.
The construction contracts for demolition, enabling including temporary works,
piling and diversion works will be procured as ‘Traditional Build’ contracts.
These construction contracts will be then novated to the Design and Build
contractor
The design to Exemplar Design level, tender action and reporting and construction
supervision of the Children’s Hospital of Ireland and Ambulatory and Urgent Care
Centre, Tallaght. It shall also include detailed design of specialist areas within the
hospital as outlined. The construction contracts shall be Design and Build
contracts.
Act as Employer Representative, in accordance with the terms of the Government
Standard Conditions of Engagement, for the Construction stages of the Project.
The duties and responsibilities will include, but are not limited to, the following:-
inspection, monitoring, testing and assessment of the contractor’s work proposals
and executed works, issuing instructions, directions and change notices as
appropriate, requesting information from the contractor, scheduling progress
meetings, assessment and certification of contractors’ progress payments, snagging
and commissioning of the works and generally ensuring that the works are being
executed in a safe and timely manner in order to meet the Project objectives.
Commissioning support and post project review of the Project.
Provision of architectural, healthcare, civil and structural, mechanical and
electrical, cost control and quantity surveying, environmental and other necessary
specialist services appropriate to the successful delivery of a large complex
Hospital Project.
Services of a Planning Consultant, PSDP and Fire Consultant shall be procured
separately. The Fire Consultant shall be novated to the Integrated Design Team.
The Site Master Plan for the new children’s hospital on the Mater Campus has been
completed. This was an extensive exercise undertaken to ensure adherence to medical
planning and urban planning principles for the new children’s hospital on the Mater
Campus. A preferred option is recommended for consideration by the Integrated
Design Team on their appointment in Oct 2009. The Site Master Plan reinforced the
potential of the ceded site to accommodate the capacity requirements of new
children’s hospital. The Site Master Plan also involved ‘future-proofing’ the facility to
allow for advances in medical technology and flexibility for change to meet future
medical advances and healthcare requirements.
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10. The current timetable for the development of the project is:
x Q3, 2009 - Completion of the Project Brief (including the Business Case):
x Q3, 2009 - Sign-off Design Brief and Project Execution Plan
x Q4, 2009 - Appointment of the Integrated Design Team
x Q3, 2010 - Preliminary foundation works with site development to begin
(subject to Planning Permission):
x 2012 / 3 Completion of the A/UCC at Tallaght (Estimated, not finalised
as subject to Planning Permission):
x Q4, 2013 - Construction of hospital completed:
x Q4, 2014 - Fit-out and commissioning of hospital:
x Q4 2014 - New children’s hospital operational:
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Item 5 (ix) 7.10.09 (JCHC) CEO Briefing Document Sept 09
Capital Expenditure 2009
1 Expenditure to Date
The Expenditure on Capital Projects by the HSE up to the end of September 2009
(excluding Dormant Accounts) was €342,744,346.70
The HSE’s original expenditure in the first half of this year amounts to €342.744m
(excluding Dormant Accounts) which is approximately €36m over the projected
expenditure of €306.788m.
The ICT expenditure is approximately €13.5m under profile and the construction
capital expenditure is approximately €49.5m over profile at this time.
3 Construction Expenditure
As detailed above construction expenditure is currently approximately €49.5m over
profile. This over expenditure will reduce by year end. Expenditure in September was
the lowest of any month and this level of expenditure will remain constant over the
remaining months of the year. The expenditure profile for these last 3 months is
higher than the anticipated spend in this period. There will also be a slight
reconciliation of the Capital Vote expenditure which will result in a minor downward
amendment to the total expenditure in October. The projected capital expenditure
overrun at year end is projected to be in the region of €30m to €35m.
This overrun is due to a number of factors which include
x The number of reductions in the HSE’s capital allocation experienced since
the start of the year
x The fact that it was anticipated that the expenditure on Mental Health projects
would be funded from the proceeds of historical sale of lands (€17.17m has
been spent on Mental Health projects to date in 2009).
x Some major projects are cashing ahead of projection due to the increased
resources contractors applied to these projects (e.g. CNU’s, OLOL Ward
Block, etc).
Commenced in 2009
Letterkenny Emergency Dept and Ward Block
Mater Adult
NIMIS Project (contract awarded)
St Vincent’s Hospital Phase 2 Enabling Works
MWR Limerick Critical Care Block (contract awarded)
NPRO Phase 1 Works at Beaumont and St James’s Hospitals
5 PCCC Projects
Commenced in 2009
Bessboro C&A Unit
St Ann’s C&A Unit Galway
Ballinasloe CNU (50 beds)
Loughrea CNU (100 beds)
St Vincent’s Fairview CNU (100 beds)
Navan CNU (50 beds)
Inchicore CNU (50 beds)
Ballincollig CNU (100 beds)
Fearnlee Rd CNU Cork (100 beds)
Marymount Cork CNU & Palliative Care Unit
St Brigid’s Crooksling Palliative Care Unit
CRC Facility Waterford
St Raphael’s Unit Cork
Item 5 (v) 7.10.09 (JCHC) Crumlin (Scoliosis Patients) CEO’s FileUpdate on
the Waiting List for Spinal Deformity Surgery in Our Lady’s Children’s
Hospital
This endeavour is to address the 70 children that are classified as the more urgent on the
waiting list in Our Lady’s Children’s Hospital and that have had all of their preoperative
assessments completed and are waiting for a surgery date.
The solutions agreed are for these specific patients and will be in addition to and not
instead of the current throughput of paediatric orthopaedic work in the hospitals. The
solutions have been made possible through the joint cooperation of Our Lady’s
Children’s Hospital, The Children’s University Hospital Temple Street, Cappagh
Orthopaedic Hospital, the Adelaide & Meath Hospitals incorporating the National
Children’s Hospital and most particularly Mr P Kiely, Mr J Noel, Mr P Connolly and
Prof D Mc Cormack orthopaedic surgeons.
Waiting List
As each of the consultants’ work in 2 of the 4 hospitals then the team on the north of the
city are undertaking the cases in CUH/TS and Cappagh and those on the south of the
city are undertaking the cases in AMNCH and OLCHC.
x By the end of September almost a third of the children have had their surgery.
x Surgery dates for a further number of patients and is being communicated to
patients and families and will be carried out in the coming months.
x A number of patients have been assessed by the consultant orthopaedic surgeons
and have had their surgery deferred for clinical reasons.
x A small group of patients have deferred their surgery for academic reasons and
will have their surgery mid 2010 and this has been clinically approved as the
deferral will not impact their condition.
Pre Operative Assessment Clinics
x All patients referred to Cappagh will attend the Pre-Operative Anaesthetic Clinic
(PAC) prior to surgery.
x All patients being referred to CUH/TS will attend a pre-operative out patient
appointment prior to surgery.
x Patients been referred to AMNCH are already aware of referral. At their last
OPD appointment this was discussed with them by their appropriate consultant
and agreed with them. AMNCH will notify the patients directly for admission
when a date has been determined. Pre assessment clinics will not be required for
these patients.
Following surgery at Cappagh Hospital and CUH/TS, patients of both Prof Damien Mc
Cormack and Mr Paul Connolly will be reviewed and followed up in the respective
hospital.
Those patients who are over 15 years of age and have agreed to transfer their ongoing
care to another Consultant in the adult services, they will thereafter continue ongoing
care in the adult service.
Item 5 (vii) JCHC – 7.10.09 – Houses in Castlepollard.
The St Peter’s Centre at Castlepollard has been in the process of actioning phase-2 of its programme to
continue the transfer of residents to smaller domestic-type, community based dwellings. Phase-1 was actioned
in 2003 with fifteen residents now living in the community, enabling the closure of the ‘Hilltop’ unit on the St
Peter’s campus. Staff on the unit relocated with residents at the time and this first phase has been a complete
success.
Phase-2 consists of the proposed closure of a full unit at the St. Peter’s Campus Manor House), relocating 17
residents to the three community-based dwellings which were recently furbished for this purpose. Residents
were selected some time ago by a selection committee, as to who were the most appropriate residents to be
prioritised for transfer to community houses. A review of all residents needs have recently been reassessed
and the outcome is known to all concerned.
The accommodation has been specifically tailored to meet the needs and challenges of these residents. It is
also anticipated that staff will pursue activities of a day service nature on and off site at the three houses and
will make use of various facilities in the local town and surrounding areas.
The details of the individual residences and the service to be provided are as follows:
Number of 6 5 6
Residents
Dependency Level High Support High Support High Support
While the aim of all concerned has been to commence services at these houses, considerable difficulties have
arisen regarding the required staffing levels, the manner of the transfer, the facilities in the houses themselves
and the prevailing circumstances which affect the provision of services. This has resulted in a series of issues
which must be overcome before the proper and appropriate opening of these residences can take place for all
1
concerned. The issues involved have been the subject of discussion by the committee and have also been
extensively focussed on and actively engaged in at local level.
Minister of State, John Moloney TD, has been given an indication that the phased opening of the residences
will commence on October 1st and this remains the intention of the HSE. Within the local Health Office for
Longford/Westmeath, extensive discussion with the Staff associations involved have been taking place with a
view to exploring every option to ensure this happens. These discussions are taking place against the
background that no increases in wte staffing numbers are permitted.
These discussions have reached an advanced stage and have been informed by a report carried out by HSE
staff members who have expertise in services for Persons with Intellectual Disability. This report was
commissioned in early July to investigate efficiencies and mechanisms within the St. Peter’s Intellectual
Disability Service that could be deployed to permit the opening of the residences.
The transfer of some services currently provided at St. Peters to other providers, with a view to freeing up
staff to facilitate the opening of the residences while remaining within existing HR resources is also being
actively pursued.
Following a tendering process, a local voluntary organisation has indicated that it will be in a position to take
over the provision of respite care services, currently provided by HSE staff in Longford Westmeath PCCC,
from November 1st this year. This Process is already underway with families. There is an agreed transition with
families and agencies to ensure a smooth transition fro these children. The transfer of this respite service to a
3rd party will allow HSE staff to be redeployed to the St Peter’s service thus partially facilitating opening the 3
community houses.
Similarly, the transfer of up to 10 of St. Peter’s residents to private nursing home accommodation and/other
is actively being explored at the moment. Assessments on possible suitable residents are complete.
Discussions are ongoing with family members of suitable residents .as well as a search using the appropriate
procedures for private nursing home accommodation that is best suited to these residents ’ needs. The
decision for clients to be moved to private nursing home must be based fully on the consent of the family
members involved.
Expressions of interest to work in the three new community residences have been invited from staff at St.
Peter’s and these have actually exceeded the required number of staff. To ensure the selection process
iequitable as possible and in accordance with proper HR procedures, a series of informal interviews have
taken place between 17-23rd September. Having gone through the selection process – a total of 29 staff have
been identified as suitable to work in community houses. These selected staff will be going through an
induction programme to work in the houses and to familiarise themselves which the clients and clients with
the community houses from 1 October 2009.
The process has also enabled the constructive re-evaluation of services which are to remain at the St. Peter’s
site, with a view to ensuring that the 43 clients who will remain are accommodated in the best possible setting
given the physical limitations as a result of the age of the building.
Given the progress made in the arrangements to free the necessary staff for the community residences and the
positivity expressed by the staff. The HSE is hopeful at the time of preparing this briefing that the transfer of
clients will be take place presently.
2
Index 5 (viii) 7.10.09 (JCHC) - Hospital Co-location Initiative (CEO’s File)
Action 79 of the Health Strategy Quality and Fairness states: “A significant proportion of
additional capacity in the acute hospital system will be supplied in future by private providers.
Government policy will aim to incentivise and attract private providers to develop private facilities, thereby
freeing up capacity in public hospitals to treat public patients. The public sector will also procure a
greater degree of services from the private sector”
Co-location is considered the quickest and least expensive means of providing significant
additional public bed capacity for public patients. No capital outlay is required as the
beds in the public hospitals are already in place, having been funded by the Exchequer.
Significant progress has been made on the Co-location Initiative. The Board of the HSE
has approved preferred bidder status for the development of co-located hospitals at the
following six sites:
Beaumont Hospital,
Cork University Hospital,
Limerick Regional Hospital,
St. James's Hospital,
Waterford Regional Hospital and
Sligo General Hospital.
Project Agreements for the Beaumont, Limerick and St. James’ sites have been signed.
The necessary preparatory work for Project Agreements in respect of Waterford
Regional Hospital and Sligo General Hospital is proceeding. Planning permission has
been sought and granted for the Beaumont, Cork and Limerick projects. A decision on
the planning permission for the St. James’ site is due in the coming weeks.
The HSE has indicated that it anticipates that the overall construction and
commissioning period will be approximately 26 to 30 months in each case.
Connolly Hospital and Tallaght Hospital, which are also participating in the co-location
initiative, are at an earlier stage of the procurement process.
The HSE and Beacon Medical Group are at present in discussion, as provided for under
the Project Agreement, in relation to certain issues with a view to ensuring that (subject
to the planning process) the co-located hospitals being developed by Beacon at
Beaumont, Cork and Limerick can be built and brought into operation as soon as
possible.
Item 5 (x) 7.10.09 – JCHC - HSE Plans for funding released from sale of Mental
Health Service lands )CEO’s File
The HSE’s organisational framework for mental health service development is based on
the Government policy published under the title ‘A Vision for Change’. The selection of
the mental health projects which are being progressed in 2009 and planned in 2010 was
based on service need, readiness to proceed and requirement to vacate premises to free
up lands to fund the remainder of the programme.
While Vision for Change and the report from the Modernisation of MH Infrastructure
Working Group clearly state the service priorities, this has to be tempered by the state of
readiness to progress projects and the necessity to sell land to fund the programme.
Therefore, projects in Clonmel, Ballinasloe, Grangegorman, Waterford, etc have to be
prioritised to allow funding to be generated, while absolute service priorities such as the
C&A Residential Units and the Acute MH Units can progress in tandem.
In 2009 the projects being progressed are those which have been proposed by the Mental
Health Services, have been through the Project Approval Process and are (in the main)
under construction.
Many of the projects which are planned to be progressed in 2010 are at or are close to
Tender Stage and will be ready to proceed once funding has been approved. A Design
Build Framework tender is now in place which will allow any Residential Unit or Acute
Ward accommodation development be progressed rapidly. Contractors will be appointed
to the Acute Unit at Letterkenny and the Residential Unit in Clonmel once funding has
been secured and the Residential units at Limerick and Waterford can follow within 6 to
8 weeks.
All of the HSE’s main current Mental Health service priorities are included in this
development programme. These priorities are
x Central Mental Hospital
x Child & Adolescent Residential Units
x Acute MH Units in Letterkenny and Beaumont
x Mental Health Primary Care Facilities (initially to be provided as part of the
Primary Care Centre Strategy)
x MH Residential Units & Hostel Accommodation
The Lands being proposed for sale in 2010 are available for sale at this time and are
relatively unencumbered (or contain lands which are unencumbered and can be released
for sale). All these lands will be (or have been) sold by public tender. The only exceptions
are where the HSE has agreed sales to the Local Authority. In this case both parties will
obtain independent valuations and negotiate from there. These transactions require
approval by the Board of the HSE and it has to be demonstrated that market value has
been achieved and the sale provided Value for Money for the HSE. While it may be
argued that a better price could be achieved by inviting bids on the open market for these
lands, in today’s market the opposite is just as likely to be the case.
The sites under consideration for sale at this time are:
Tuas Nua, Kildare Sale agreed (open tender) for approx 3 acres for €1.5m.
Another 7 to 8 acres are available for sale
St Loman’s Mullingar Sale agreed with Local Authority, 6 acres for €3.5m
St Luke’s Clonmel Sale agreed with Local Authority for 200 acres approx.
Payments to be phased. May have to be re-tendered.
Our Lady’s Hospital Cork Sale agreed with Local Authority. 17 acres for €10m.
Payments to be phased. Comprises a vacant site and
buildings.
St Conal’s Letterkenny 40 acres around building available now for sale
St Finian’s Portlaoise 10 acres available now for sale
St Canice’s Kilkenny 20 acres available now for sale
St Brigid’s Ballinasloe 110 acres available now for sale (including some
buildings) Other land to follow.
Enniscorthy Over 200 acres can be sold. First tranche available for sale
now.
Kelvin Grove Carlow 8 acres available for sale now.
Item 6(i) JCHC – 7.10.09 (C&AG) Dublin Ambulance Srevices
The following document sets out the actions to date and the proposed action in
relation to the C&AG Report recently published. In particular it refers to Chapter 40-
titled Dublin Ambulance Service. It also includes the updated position in relation to
Pre-hospital provision within Carrick-on-Suir.
Work in relation to the Audit concerns and conclusions within the above report have
already begun.
Both the HSE National Ambulance Service and Dublin City Council Fire Brigade
have established an inter service project management team to implement a seamless
service, in order to respond to the needs of the patients within the catchment area of
Dublin, Wicklow and Kildare.
This has taken the form of rationalising the control rooms in the Eastern Region of
Dublin Mid-Leinster from four to three which will eventually become two over the
next three months.
In order to deliver this integrated approach the project team are developing policies
and procedures, reviewing existing information technology systems, to ensure that the
catchment area of Dublin City and County have a single point of contact, and an
immediate response.
Over the next three months new technology in the form of an advanced medical
priority dispatch system will be introduced and this will assist in developing the
appropriate resource to the emergency. A Memorandum of Understanding is being
developed to ensure that ongoing governance arrangements operationally, clinically
and financially are clearly set out and agreed. This Memorandum of Understanding
will be continually reviewed in line with service changes in consultation by both
parties.
On a National basis, option appraisals and a cost benefit analysis has already been
completed and the output from both pieces of work have indicated the need to have
two national ambulance control centres, with one to be based in the HSE West and a
second in Dublin Mid-Leinster, serving the total population.
The outcome from these evaluation processes have been shared with the Department
of Health & Children and the Health Information Quality Authority and are at the
centre of ongoing discussions with both organisations.
Draft project scoping documents have been developed, however more detailed
planning is required in order to achieve the desired future state of service provision.
Carrick-on-Suir
The spatial analysis report for the South Eastern region has indicated that Carrick-on-
Suir be resourced via a dynamic standby model. The dynamic standby model is a
model based on the level of activity and response time performance. This means that
ambulance resources will be dispatched to the Carrick on Suir area for standby
periods based on the activity in the Carrick-on-Suir area. The dynamic standby points
maybe the local primary care centre, shopping centre facilities, schools or an
alternative appropriate site. For example predictive analysis of the historical
information may illustrate a trend that at a particular time of day, day of the week,
week of the month that there is a high indication of road traffic collisions. The
dynamic response in this case will be to have the ambulance resource on scene in
anticipation of a collision. This is an international approach by ambulance services to
improve the response to patients and improve the clinical intervention and subsequent
clinical outcomes. The other factor is that the presence of an ambulance in this area on
a regular basis will become known to the local community and therefore act as a
mechanism for drivers to take more care. This approach will undoubtedly enhance
the service provision to the population. This coupled with the consideration of a
report on the reconfiguration of acute services will further develop the appropriate
pre-hospital model of care within the overall South Eastern region.
Item 6 (ii) 7.10.09 (JCH) – Consultants Contract (CEO’s File)
Implementation of Consultant Contract 2008 – Briefing Note
28th September 2009
Table of Contents
1. Key points...................................................................................................................................2
7. Teamworking..............................................................................................................................5
1
1. Key points
Consultant Contract 2008 introduces a range of reforms which will benefit patients, help
develop a consultant-provided service and ensure that maximum value for money is
obtained from the investment in existing and additional Consultant posts.
Consultant Contract 2008 provides for a 37 hour working week delivered over the period
8am – 8pm Monday to Friday. In addition, Consultants rostered on-call may be
scheduled to work on-site for up to 5 hours on Saturday, Sunday or public holidays.
This contrasts with the Consultant Contract 1997, which provided for a 33 hour week,
delivered over the period 9am – 5pm Monday to Friday with no provision for scheduled
on-site work at weekends.
Together with a series of measures introduced by the HSE in recent months, Consultant
Contract 2008 introduces a series of measures designed to improve equity for public
patients, including a limit on private practice – for new Consultants – of 20% of clinical
activity. Existing Consultants may engage in up to 30% private practice.
i. Type A: Works exclusively for the public hospital and will be remunerated solely
by way of salary.
ii. Type B: Works exclusively for the public hospital by may engage in limited
private practice on campus (80% public, 20% private).
The measure include requirements that all patients – public or private – requiring
diagnostic or treatment procedures following an outpatient consultation must be placed
on a Common Waiting List if there is a waiting period for access to the procedure.
2
A Common Waiting List is one which includes all patients – irrespective of public or
private status – awaiting a particular procedure.
Patients must be called from Common Waiting Lists regardless of public or private
status:
Section 21 of Consultant Contract 2008 sets out the circumstances under which the
Consultants employed under Consultant Contract 2008 may charge private fees in
relation to private patients undergoing diagnostic investigations, tests and procedures on
an outpatient basis. These are as follows:
x the volume of such private practice not exceeding the set ratio of public to
private practice (a maximum of 30% for existing Consultants in employment
when offer of Consultant Contract 2008 was made in July 2008, 20% for new
appointees).
x A common waiting list operated by the public hospital applying to both public
and private patients undergoing diagnostic investigations, tests and procedures
(including radiology and laboratory procedures) on an out-patient basis in public
hospitals (including referrals from General Practitioners). Status on the common
waiting list will be determined by clinical need only. The list will be subject to
clinical validation by the relevant Clinical Director.
All outpatient diagnostics are included as regards the Common Waiting List. For
example, outpatient diagnostic tests and procedures in cardiology, neurophysiology and
gastroenterology.
Section 20 of the Consultant Contract 2008 deals with the regulation of private practice
and the mechanisms for ensuring compliance with the 80:20 / 70:30 ratio of public to
private practice. It provides that the volume of private practice may not exceed the
specified ratio in any of the Consultant’s clinical activities including inpatient, day-patient
and outpatient.
3
The volume of practice refers to patient throughput adjusted for complexity through the
casemix system. It does not include non-clinical activities, nor does it apply to time.
Section 20 of the Contract states that the Employer has full authority to take all necessary
steps to ensure that for each element of a Consultant’s practice, s(he) shall not exceed the
agreed ratio.
“both the Consultant and the Employer shall co-operate in giving effect to such
arrangements as are put into place to verify the delivery of the Consultant’s
contractual commitments”
x The ESRI has been central to the development of the measurement system, which
has now been rolled out to the 49 acute hospitals through the HIPE (Hospital In-
Patient Enquiry) system. The measurement system captures inpatient and day case
activity (as weighted for case mix) per consultant and reports on the level of private
practice on a monthly basis.
x Where residual activity which is not yet captured by the HIPE system (e.g. details
of on-site private OPD activity and certain diagnostic activity) is being collected
manually by hospitals as an interim measure pending the development of
automated data collection systems.
x Each Consultant in the employment of the public health service – irrespective of
whether they hold Consultant Contract 2008 or not - should be issued with a
public private mix measurement report every month since January 2009. This
documents their activity in relation to inpatient, daycase, outpatient and diagnostic
activity over the previous three months. The report is also issued to the relevant
Clinical Director and Hospital Manager / CEO for consideration and to facilitate
action to ensure with Consultant Contract 2008.
x An overall status report is also prepared for internal HSE monitoring and
management purposes and monitoring. From the January 2009 reporting period
this report is considered as informing decisions by Clinical Directors and managers
on individual Consultant compliance on a contractual basis. It will be provided
monthly to the HSE Board, the Department of Health and Children and will be
available under FOI.
x There is an inevitable time lag (minimum of 4 months) in providing reports due to
the time required for coding activity from the patient charts.
4
A small number of hospitals are still dealing with data collection difficulties, particularly
with the reporting of on-site private OPD activity and diagnostics.
In this context, the HSE has instructed that - should Consultants engage in private
outpatient practice on campus such practice should, like all other public or private
activities undertaken on the public hospital campus, be subject to measurement as part of
the 80:20 / 70:30 ratio of public to private practice under Consultant Contract 2008.
Measurement includes co-located hospitals on campus, private rooms on campus and
private clinics on campus – with three exceptions. The exceptions are the private
outpatient practice of existing Consultants in private clinics (as of 26th July 2008) on the
campus of St James’, Beaumont and Cork University Hospital.
The HSE has issued a substantial volume of guidance on the measurement of public :
private practice, including three volumes of guidance on the implementation of
Consultant Contract 2008, separate guidance on the measurement of inpatient and
daycase activity, diagnostic and outpatient activity most recently, in September 2009,
comprehensive guidance on the treatment of public and private patients.
Consultant Contract 2008 requires that the Consultant – while clinically independent – is
subject to statutory and regulatory requirements and corporate policies and procedures.
Consultants will be expected to work in teams, participate in competence assurance
arrangements and provide education and training to other clinicians.
The Contract also requires that new appointees to Consultant posts must now be eligible
for membership or have membership of the relevant division of the Register of Medical
Specialists maintained by the Medical Council. This means that patients can be assured
that Consultants meet the highest standards – both when appointed and throughout their
careers.
7. Teamworking
Consultant Contract 2008 offers a significant opportunity for hospitals to achieve greater
flexibility in relation to the delivery of services to patients and move to a Consultant-
provided service.
Consultants are on-site for longer periods – meaning that there is a greater senior clinical
decision-making presence on-site. Key service enhancements can include:
5
x Rostered daily ward rounds that deliver improved Discharge Planning to address
bed occupancy rates;
x Reduced overtime costs for NCHDs arising from a Consultant-provided service
– €100 million in savings currently being negotiated with NCHDs.
x Theatre Schedules that reflect a shift to day work and address elective waiting
times and deliver improved equity across specialties. This should ensure
inappropriate queue-jumping related to patient designation is addressed;
x Re-designation of inpatient beds to day beds to improve day case throughput;
x Re-designation of 7 day to 5 day beds that promotes reduced length of stay,
allows for improved budgetary performance and eases pressure on WTE
rostering and staff;
x Improved day of surgery admission rates;
x OPD schedules that reflect increase in new patient consultations while decreasing
return patient reflecting new ratios and reductions in DNA's to 5% target
through improved scheduling.
x Improved access rates for GP's to diagnostic services by ring-fencing additional
Consultant hours to direct access initiatives for GP diagnostic radiology, scoping
etc;
x Improved clinical governance through the Clinical Directorate model that
facilitates the relevant Quality and Risk frameworks, Serious Untoward Incident
policies and maintenance of Risk Registers;
x Improvements in compliance with Hospital Accreditation, Medical Records
Audit, and Hygiene standards
Consultant Contract 2008 introduces a new senior management position across the
health service – that of Clinical Director. Consultant Contract 2008 describes Clinical
Directors as key members of the local corporate management team. Clinical Directors
are expected to plan how clinical services are to be delivered, how resources are
employed, contribute to strategic planning and achieving service and organisational
priorities and deploy and manage Consultants.
The Contract requires that each Consultant will report to a Clinical Director who ensures
service standards and governance requirements are met; monitors and manages
public:private mix; develops and manages rosters (with an emphasis in the short to
medium term on move to an 8am – 8pm day and obtaining value from the additional 4
hours per Consultant per week) and deals with grievances and disputes, manages the
initial stages of the disciplinary process, and helps organise medical education and
training.
The HSE is working with the Forum of Postgraduate Medical Training Bodies and a
number of sub-groups to develop the role of and support the work of Clinical Directors
6
To date, 35 Clinical Directors have been appointed across the hospital system from
amongst those Consultants who accept Consultant Contract 2008. A further 14 have
been appointed in the Mental Health Services. Further Clinical Director appointments
will made over the next two years as services evolve. Up to 77 appointments may be
made in total. Appendix I refers.
Of the 1,888 permanent Consultants, negotiations continue between the Universities, the
Department of Education and Science and the Higher Education Authority on the offer
of the contract to 150 Academic Consultants.
An element of the HSE vote for 2009 was transferred to the Department of Education
and Science and subsequently to the HEA and the Universities to fund the offer of
Consultant Contract 2008 to Academic Consultants. The HSE has no further
involvement in the matter.
In June, some of the Universities employing Academic Consultants began the offer of
Consultant Contract 2008 to those Consultants in their employment. At 7 July 2009,
around 50% of Academic Consultants had accepted the terms of the new contracts.
By July 2009, 1,688 consultants out of the 1,888 permanent consultants had accepted the
offer of Consultant Contract 2008. This represents an acceptance rate of approximately
90%. The breakdown by Contract Type is as follows:
x Type A: 629
x Type B: 703
x Type B*: 356
In March 2008 the IMO and IHCA agreed to advertisement of Consultant posts under
Consultant Contract 2008. Following this agreement, the HSE approved 128 Consultant
posts which were advertised by the Public Appointments Service throughout April.
In the period up to 31st December 2008, a further 155 posts were approved – for a total
of 283 posts in 2008. 156 of these were new posts and 127 replacement.
During 2009 and noting the constraints imposed by the Government Recruitment
Moratorium which requires the abolition of two NCHD posts for every Consultant post
approved, the HSE approved 127 Consultant posts – 65 additional and 68 replacement.
Of the posts approved in 2009, 18 were Type A, 109 Type B, none Type C.
This means that during the period March 2008 to September 2009 the HSE approved
221 new Consultant posts and 195 replacement. This represents an increase of 10.4% in
7
the number of Consultant posts in an 18-month period. There are now 2,342 Consultant
posts in the Irish public health service.
Tables setting out the current distribution of Consultant posts and the distribution of
additional posts between March 2008 and September 2009 are set out below:
Each signed Consultant Contract was reviewed and documented by HSE Internal Audit
as part of an internal audit process. This was a key means of ensuring that the significant
contribution made by Consultants to the delivery of health services was recognised and
recorded, that there was absolute transparency on the delivery of public hospital services
and that value was achieved for the resources allocated to contract implementation.
The review examined all contracts issued and accepted by consultants employed in the
HSE and HSE funded agencies. Each contract was reviewed to identify any alterations to
the standard terms and conditions contained in the pro forma contract agreed with the
medical representative bodies in July 2008. The review found:
8
x The vast majority of contracts signed by consultants and authorised by the employer
were in accordance with the standard terms and conditions;
x A very small number of contracts did contain manual amendments relating to the
treatment of private out-patients, however, these were not found to materially affect
the standard terms and conditions.
The HSE Human Resources Directorate also engaged in a verification process for the
1,385 permanent Consultants who have accepted the offer of Consultant Contract 2008
to confirm that the arrangements below were in place.
a) Appropriate standardised Contract documentation
Following the HSE’s verification process and to ensure the gains to patient services from
the new contract were secured, the Minister for Health & Children set out in a statement
on the supplementary budget of the 7th April 2009 that the Consultant Contract was to
be implemented on the basis of part payment of the new Consultant Contract salary
rates.
Approximately half of the differential between the 1997 and 2008 salary rates was to paid
in 2009 as and from 1st January 2009. The original payment schedule had identified the
9
new rates for Consultants accepting the new contracts to apply from the 1st June 2008.
The other half scheduled for the 1st June 2009 was not sanctioned and has not been
sanctioned to date.
The HSE has no authority to make payments other than those approved by the Minister
for Health & Children.
The 3rd Interim Report of the Public Accounts Committee on the 2006 Report of the
Comptroller and Auditor General regarding health service expenditure recommended
that:
x the new contract should provide absolute transparency on the time commitment to
public hospital duty of Consultant staff: These commitments should be monitored
and enforced in order to ensure that value is received for the salaries paid to
Consultants
x the HSE should introduce a stringent monitoring regime of public and private
caseloads in hospitals and publish data on the level of private practice in public
hospitals;
x the terms of the 1997 contract should be strictly enforced in respect of those
consultants who do not transfer to the new contract so that these consultants are
seen to deliver services in accordance with their commitments
x six-monthly progress reports should be provided to the Minister for Health and
Children.
The HSE’s implementation of key provisions of the 2008 Contract has significantly
addressed the recommendations of the Oireachtas Public Accounts Committee regarding
Consultant Contracts.
In addition, the HSE has moved to ensure that the provisions of Consultant Contract
1997 regarding the Consultant’s private practice being aligned with the number of
designated private beds is enforced.
10
Appendix I – Clinical Directors appointed under Consultant Contract 2008
11
Dr Garry Courtney, Consultant
19 St. Luke's Hospital, Kilkenny
Physician
12
Clinical Directors in Mental Health
13
Item 6 (v) 7.10.09 (JCHC) C&AG – Private Income (CEO’s File only)
Government policy has been to ensure that there is equitable access for public
patients, that the proportion of private activity in public hospitals is appropriately
controlled and as far as possible additional resources provided to the hospital system
benefit public patients in the first instance.
Action number 88 of the 2001 Health Strategy provided for the following:
“All of the extra Acute Hospital capacity within the public sector, both in- patient
beds and day beds, will be designated for use by public patients. The only exceptions
will be Intensive Care Units, Coronary Care Units and other specialised beds which
will continue to be non-designated. The provision of additional beds announced in
this Strategy will be a significant step forward in ensuring that the needs of public
patients are adequately met”.
On average 20% of beds in the public hospital system are designated as private or
semi-private. Currently approximately 52% of the population hold private health
insurance.
The current bed designation system could not therefore ensure that all private patients
are charged a maintenance charge by the hospital in which they are treated. The
Health Service Executive is only entitled to charge private patients who occupy
designated private beds.
The Comptroller and Auditor General’s report noted that 45% of all private in-patient
throughput was not the subject of a maintenance charge because the patient was
accommodated in a public bed. The main reason for this is that public patients were
accommodated in private beds for infection control and clinical reasons relating to
patient safety together with the fact that private patient activity is limited in public
hospitals as a matter of Government policy.
The Comptroller also noted that 5% of private patient activity was not charged for
because the patient was accommodated in a non-designated bed.(e.g. Intensive Care,
Coronary Care and other specialised beds). It is a matter of Government policy that
there is no charge levied for non-designated beds and the policy rationale for non-
designated beds is that accommodation for persons who are acutely ill or where a
national specialty is concerned should not be differentiated into public an private.
This was done to ensure that it is solely clinical factors which determine which
patients are accommodated in those facilities.
The Comptroller and Auditor General further noted that the full economic cost of
maintenance in public hospitals is not being levied at present. However there has been
significant increases in recent years in the proportion of that cost recovered and in
2009 this charge was increased by 20% in a move to close the gap.
The Department of Health and Children has recently set up an independently chaired
group to establish the most appropriate way of charging the full economic cost of
providing services to private patients in public hospitals.
The Health Service Executive fully accepts that the delay in recovering private
insurance accommodation claims is excessive and has set in motion a number of
initiatives to resolve this issue. The timeliness of debt recovery is a cash flow issue for
the H.S.E. and 97% of all private insurance claims are ultimately paid by the insurer.
Hospital Managers have been instructed to reduce their debtor days down to 60 days
initially and budget sanctions will be imposed on Managers who fail to reach this
target in 2010.
A high level group chaired by a Hospital Network Manager and with representatives
from H.S.E finance and Voluntary Hospitals has been established to negotiate with
the Private Insurance Providers on business processes and the reduction of debtor
days and with the following terms of reference.
Negotiations are ongoing with the Private Insurance providers to implement electronic
exchange of data which will significantly speed up the claims and payment process.
The H.S.E has secured agreement with the major insurance providers for signoff of
claims by a secondary Consultant Clinician where the primary Consultant has failed
for whatever reason to signoff in a timely manner.
Approval has been obtained from the Department of Health and Children and the
Department of Finance to commence the centralisation of the entire H.S.E billing
system which will lead to streamlining of this process and focus the attention on
collection of all outstanding debts.
ON
and the
The Public Accounts Committee has also considered these matters in some detail.
In this context a decision has been taken by the HSE that these issues could be best
addressed if the Primary Care Schemes were operated centrally. In order to be
managed more effectively and consistently from a national perspective it has been
decided to centralise the core operation of these schemes in one location, namely the
HSE Offices at the Primary Care Reimbursement Services (PCRS) in Finglas, Dublin,
with Local Health Offices continuing to provide local assistance and advice to the
public as normal.
The proposed changes are intended to address the concerns set out above and
enhance service delivery to the client. There will be no impact on patient care or the
quality of service provided and there will be no affect on the assessment of people
whose income exceeds the guidelines but have a case to be considered on medical or
hardship grounds. The HSE is aiming for significant improvements in turnaround
time for all completed Medical Card/GP Visit Card applications. A fast track process
is already in place in the new central office in Finglas, which is currently dealing with
all of the applications and life cycle events of the Over 70’s clients, to cater for
special emergency cases, with emergency applications dealt with immediately, and a
card issuing within 24 hours. It is anticipated that most such emergency requests will
come through Local Health Offices following contact by clients or the local health
services.
There are no plans to close any of the local health offices that currently process
medical card and GP visit card applications. However, the process will involve a
reassignment of existing human resources within the HSE. Local Health Offices will
continue to provide service to clients of these schemes by providing information and
assistance to clients about their entitlements, and they will also provide assistance
with the completion of application forms etc. An on-line tracking service linked to
the central processing centre at PCRS will be available in Local Health Offices to
provide clients with information on their current eligibility status or the progress of a
client’s application.
Page 1 of 20
The reorganisation will facilitate the application of a consistent approach to assessing
eligibility across the country and will:
It is envisaged that other HSE services, e.g. Public Health Nursing Departments,
Paramedic services and Doctor on Call services, Hospitals etc. will also be in a
position to determine the eligibility of a client for services by accessing the national
on-line system at PCRS. A small group is currently engaged in scoping the
requirements of these services.
This re organisation will reduce the numbers of staff required to work in the schemes
process in Local Health Offices without reducing the level or quality of service
provided to the public, and will provide staff with an opportunity to move to
developing services such as Primary Care Teams.
The HSE would view this change as the type of innovation signalled in the
Transforming Public Services Programme announced by the Taoiseach last
November. It demonstrates how the HSE can deliver improved services within the
more limited resources available in a way that meets the needs of citizens in a modern
society.
2. To ask the Minister for Health and Children and the HSE Chief
Executive the process by which they are assessing the proposals
regarding healthcare provision within the Report of the Special
Group on Public Service Numbers and Expenditure Programmes
(the McCarthy Report), and if the preliminary conclusions have
been reached or decisions made in relation to these proposals.
The Department of Health & Children will provide response to this question.
3. To ask the Minister for Health and Children and the HSE Chief
Executive for an update on the FairDeal (Nursing Homes Support
Scheme Act 2009) scheme, including details on: when it will
commence, proposed changes to the scheme and if negotiations
have been completed with nursing home people etc.
The Department of Health & Children will provide response to this question.
Page 2 of 20
4. To ask the Minister for Health and Children and the HSE Chief
Executive for an update on the HSE budget and proposed
redundancy programme.
Performanceȱyearȱtoȱdate
The HSE is substantively delivering upon its Service Plan in terms of service levels,
employment and finances. As indicated above there are a number of newly emerging
pressures that are driving cost upward.
We anticipate that the VFM target of €115m will be achieved by year end on the
basis that the saving trend from 2008 is repeated. The VFM delivery of 2008 of
€280m will be maintained. It is clear that some measures relating to non basic pay
reduction and service reconfiguration are not delivering or are delayed in
implementation due to industrial action. We are assessing the effect of other
measures that have been taken locally to compensate for these challenges.
The gross vote is €162m ahead of profile at the end of September 2009. The HSE is
continuing to take action to address this and working with the Department of Health
and Finance on some key emerging issues.
Risks
The key risks to be considered between now and year end in terms the vote include
the following;
Page 3 of 20
Appendix 1
Budget adjustments based upon letter from Minister
€m
Total without measures in place at Special Board
Meeting - 23 February 2009 469
Implementation of the reduction in the wholesale margin
following the Minister's approval (50)
Health Repayment Scheme - costs which will not arise
until 2010 (12)
Funding provided in REV for health levy (160)
Assurance provided in Minister's letter regarding
supplementary funding for medical cards (100)
147
National Treatment Purchase Fund transfer (10)
Transfer from other health agencies (3)
Further reductions to be specified (9)
Savings on consultant contract determined by the
Department of Health & Children (75)
Acceleration of VHI outstanding monies (50)
Balance remaining -
Page 4 of 20
Appendix 2
Pensions
The following table shows how pension lump sums have grown since 2008. Given the
range of staff within the organisation who can validly choose to retire before the end of the
year, it is very difficult to predict the ultimate cost of lump sums in 2009 (this includes all
staff who have reached age 60, psychiatric nurses etc).
Accelerated retirements are a problem which has been affecting the public service generally
since the introduction of the emergency budget, the pension levy and speculation regarding
taxing of lump sums. It is not unique to the HSE.
Using data to the end of June 2009, the estimated potential full year deficit is in the order
of €80m. However there was further growth in lump sum payments in July 2009 and it is
more prudent to increase our estimate to €95m at this point.
In addition to lump sum increases, pension payments have also grown and anticipated
increased income collection from the consultants pay award and demographic staff costs
have not materialised. These 3 factors contribute to the forecast overrun of €95m.
Page 5 of 20
The HSE does not have a proposed redundancy programme apart from the question
of the Incentivised Scheme for Early Retirement (ISER). The Minister for Finance
announced the introduction of new incentivised schemes for public servants as part of
the budget on 7th April 2009. These schemes include the Incentivised Scheme for
Early Retirement, Special Incentive Career Break Scheme and the Shorter Working
Year Scheme. The ISER and other schemes were advertised in the Health Sector on
receipt of the requisite Departmental Circulars on the 18th May 2009.
Unfortunately, the HSE suspended the availability of the schemes following the issue
of a “directive” issued by the joint group of health unions. This “agreed-directive”
directly contravened the expressed condition contained in the original circular that staff
co-operation and flexibility in respect of redeployment and mobility was a requirement
for making these schemes available. Consequently this action had the effect of
restricting the operation of the scheme and the ability of the Organisation to ensure
continuity of its affairs.
The HSE has been actively pursuing the matter in an effort to find a resolution. To
date this has not been successful. A total of 230 applications for access to the ISER
(121 in HSE, 109 in Voluntary Hospitals, Disability and other agencies) have been
received to date.
5. To ask the Minister for Health and Children and the HSE Chief
Executive when will residential services for children with a disability
be inspected and registered.
The Department of Health & Children will provide response to this issue
6. In view of the call from the Human Rights Commission and Patient
Support Groups will the government reconsider its decision not to
establish an external review into the practice of symphysiotomy in
Ireland.
The Department of Health & Children will provide response to this question.
Page 6 of 20
7. What protocols are currently in place to deal with people who
present themselves at psychiatric units with suicidal tendencies and
if there are procedures in place to contact the family of psychiatric
patients when they are being discharged from hospital.
Psychiatric Units accept referrals from Community Mental Health Teams and
General Practitioners. In some instances, clients self refer and in these circumstances
staff perform an assessment on the patient. If there are concerns in relation to the
patient’s health, the Consultant on call will undertake a psychiatric assessment and
depending on the outcome, invite the patient to stay if clinically indicated or offer an
early appointment at an appropriate community facility. These facilities may include
an outpatient clinic, day hospital or follow up home care.
With their expressed permission, family members and carers of the patient can be
invited to become involved in the care programme. This is the HSE preferred model
and indeed is the model recommended in “A Vision for Change” to work with, but
this is dependent on the agreement of the individual concerned. We are bounded by
patient confidentially which we must respect.
The HSE is committed to extending and enhancing primary and community service
models as a preferred approach to providing care to mothers and babies with
uncomplicated pregnancies and treatment needs. We recognise the centrality of
clinical involvement and leadership in the design provision and improvement of
care. The role of the midwife is recognised as being fundamental to delivering
women and baby-centred maternity services.
Page 7 of 20
partnership with obstetricians and other members of the healthcare team in the
provision of care, particularly to women with complicated pregnancies.
The HSE has made a commitment in its Transformation Programme to develop its
strategic approach to Maternity Services nationally and this started in 2007 with the
Independent Review of Maternity & Gynaecology Services in the Greater Dublin
Area. The HSE/KPMG report on the Review of Maternity & Gynaecology services
in the Greater Dublin Area was published in February 2009 and is available on
www.hse.ie. The report is an integral blue print for maternity and gynaecology
services. The review provided an opportunity for organisations and individuals to
debate and exchange ideas for positive change maximising improvement for
mothers and babies in terms of the model of care and choice/safety agenda.
The report concluded that Dublin’s current model of stand alone maternity hospitals
is not the norm internationally. It is well recognised that for optimal clinical
outcomes maternity services should be located with adult acute services. This
allows the mother to access a full range of medical and support services should the
need arise for (for example) cardiac and vascular surgery, diabetes services,
intensive care facilities, haematology services, psychiatric services among others.
The development of co-located Midwifery led Units (MLUs) alongside obstetric
units is a key recommendation for the Greater Dublin Area. Pilot co-located MLUs
were established in 2004 in the North East area in Cavan General Hospital and Our
Lady of Lourdes Hospital in Drogheda and are still ongoing. These units are
currently being evaluated by the School of Nursing and Midwifery Trinity College
Dublin and early indications are that they are popular with women. Formal
evaluation of these MLUs is imminent.
We are aware of the desire of all parties to progress the implementation of the
HSE/KPMG report recommendations and we are arranging to put in place
appropriate national, regional and local level supports for the work streams
identified across service redesign, workforce needs, clinical governance, teaching
and training and physical infrastructure requirements.
With regard to out-of-hours services for those who are at risk of self-harm or suicide,
or those who have mental health problems, the HSE provides 24-hour Mental Health
Services. Out-of-hours services can refer clients to acute Psychiatric Units where
patients are assessed and either admitted or offered follow up out patient inputs.
Clients who are acutely ill and present as a risk to others or indeed themselves can be
admitted on an involuntary basis to an acute Psychiatric unit under the provision of the
Mental Health Act 2001, where appropriate psychiatric interventions can be provided.
Page 8 of 20
For clients where a full psychiatric assessment and interventions are required, these are
arranged through the Consultant Psychiatrists and their on-call team.
The specific role of the crisis nurse is to take a full psychosocial history and define
problem areas with the client, aiming to identify psychiatric illness, suicide risk or co-
existing problems. This enables the most appropriate intervention(s) to be offered and
the crisis nurse also liaises with the client’s family or significant others to engage the
most appropriate person with the nurse and the client beyond the initial intervention.
Crisis Nurses take the responsibility to devise care pathways for the client which
encourage management and solving of problems being experienced, thus opening the
possibility of options other than DSH or suicide to the client. Home care follow up for
up to six weeks after the incident is also provided, as is liaison with the client’s GP and
other voluntary or statutory services of all types in the community which can provide
assistance tailored to the client.
Child Protection:
Regarding out-of-hours child protection, the HSE has established the Emergency Place
of Safety service earlier this year. This service enables Gardaí to access an appropriate
place of safety for children found to be at risk out of hours (outside normal working
hours, 5pm-9am Monday to Friday and weekends and bank holidays) under Section 12
of the Child Care Act 1991.
Under the Act, an Garda Síochána has sole legal responsibility where there is an
immediate and serious risk to the health or welfare of a child, and it would not be
sufficient for the protection of the child from such immediate and serious risk to await
the making of an application for an emergency care order by the HSE under section
13, to remove the child to safety.
The Emergency Place of Safety service provides a standardised response across the
country for children who can be appropriately placed in a family setting. This service
applies outside the Dublin, Kildare and Wicklow areas. Such services are available
currently for these areas.
The HSE retains custody, within the meaning of section 12 of the Child Care Act,
1991, through its agent Five Rivers Ireland, of a child placed with Five Rivers Ireland
by the Garda Síochána under section 12(3) of the Child Care Act, 1991. Day to Day
care will be provided by Five Rivers Ireland as agent for the HSE.
The service conforms with relevant Child Care Regulations and with the National
Standards for Foster Care.
Page 9 of 20
A joint HSE/Garda Protocol provides a code of conduct and set of standardised
procedures for staff of the HSE and members of the Garda Síochána in the placement
of children with Five Rivers Ireland in the operation of this service.
This protocol outlines an agreed procedure between the Health Service Executive and
the Garda Síochána and clarifies the roles and requirements of the agencies in relation
to the placement of children out of hours by the Garda Síochána under Section 12 of
the Child Care Act, 1991.
Of the referrals, 26 (41%) were appropriate and placements were provided for children
with Five Rivers Carers; in two cases (3%) the referral was appropriate but there was
no placement available. Of the referrals 10 (16%) were inappropriate as children
already had a care placement, in four cases (6%), referrals were appropriate and
placements were offered but refused. In the remaining 21 referrals (33%) advice about
an appropriate place of safety service e.g. acute hospital or psychiatric evaluation or
another course of action was provided.
Elder abuse
Regarding out-of-hours services for Elder Abuse, the HSE has made significant
progress in the provision of a dedicated elder abuse service over the last two years. The
HSE has taken a number of initiatives to prevent and combat elder abuse including:
x The appointment of Senior Case Workers in Elder Abuse. There are currently 28
Senior Case Workers in Elder Abuse providing a service in almost all of the Local
Health Offices. In addition, there are three Dedicated Officers in Elder Abuse who
provide training, advice and expertise in the area of elder abuse.
x A comprehensive national and local media campaign. In 2008, the HSE launched a
comprehensive national and local media campaign in order to raise awareness of
elder abuse. The campaign included local and national radio advertisements,
national and regional newspaper advertisements, the distribution of almost 500,000
information leaflets and a number of radio and television interviews by HSE staff
in relation to elder abuse.
x The establishment of a National Centre for the Protection for Older People in
UCD. The National Centre was established in 2008 and will provide original
research on elder abuse in Ireland as well as acting as an advice and resource centre
for the HSE and other groups.
x Significant training of staff, both within the HSE, and private and voluntary
organisations, has been undertaken in order to help staff recognise and respond
appropriately to elder abuse.
x A comprehensive HSE database has been established which records the number
of abuse referrals, the types of abuse, age profile of abuse victims and other details.
Page 10 of 20
In 2008, a total of 1,840 elder abuse referrals were made to the HSE. Up to the end of
August, 2009, the figures show a consistent referral pattern, with 1,225 referrals. The
HSE elder abuse service focuses on training people in how to recognise and respond to
abuse, preventing abuse from happening and stopping abuse when it occurs. The HSE
senior Case Workers, in dealing with cases of elder abuse, work with, and respect, the
wishes of the older person as much as possible.
The service does not have dedicated out-of-hours provision. However, if a situation
arises in which there is an immediate and potentially serious risk to an individual, there
are emergency services in place. These include GP services, community nursing teams,
accident and emergency departments and An Garda Siochana. All of these agencies,
depending on the situation, would have close working relationships with the Senior
Case Workers on Elder Abuse and training is provided to these groups on an ongoing
basis.
10. Does the Minister have an update on the timeline for the
introduction of HPV vaccine for 12 year old girls?
The Department of Health & Children will provide a response to this question.
11. What is the Department doing about the monitoring of the new
common contract?
1. Key points
Consultant Contract 2008 introduces a range of reforms which will benefit patients,
help develop a consultant-provided service and ensure that maximum value for money
is obtained from the investment in existing and additional Consultant posts.
Page 11 of 20
This contrasts with the Consultant Contract 1997, which provided for a 33 hour week,
delivered over the period 9am – 5pm Monday to Friday with no provision for
scheduled on-site work at weekends.
(i) Type A: Works exclusively for the public hospital and will be
remunerated solely by way of salary.
(ii) Type B: Works exclusively for the public hospital by may engage in
limited private practice on campus (80% public, 20% private).
The measure include requirements that all patients – public or private – requiring
diagnostic or treatment procedures following an outpatient consultation must be placed
on a Common Waiting List if there is a waiting period for access to the procedure.
A Common Waiting List is one which includes all patients – irrespective of public or
private status – awaiting a particular procedure.
Patients must be called from Common Waiting Lists regardless of public or private
status:
Section 21 of Consultant Contract 2008 sets out the circumstances under which the
Consultants employed under Consultant Contract 2008 may charge private fees in
relation to private patients undergoing diagnostic investigations, tests and procedures
on an outpatient basis. These are as follows:
x the volume of such private practice not exceeding the set ratio of public to
private practice (a maximum of 30% for existing Consultants in
employment when offer of Consultant Contract 2008 was made in July
2008, 20% for new appointees).
Page 12 of 20
Employer has full authority to take all necessary steps to ensure that for
each element of a Consultant’s practice, s(he) shall not exceed the agreed
ratio.
All outpatient diagnostics are included as regards the Common Waiting List. For
example, outpatient diagnostic tests and procedures in cardiology, neurophysiology
and gastroenterology.
Section 20 of the Contract states that the Employer has full authority to take all
necessary steps to ensure that for each element of a Consultant’s practice, s(he)
shall not exceed the agreed ratio.
“both the Consultant and the Employer shall co-operate in giving effect to such
arrangements as are put into place to verify the delivery of the Consultant’s
contractual commitments”
Page 13 of 20
x The ESRI has been central to the development of the measurement system,
which has now been rolled out to the 49 acute hospitals through the HIPE
(Hospital In-Patient Enquiry) system. The measurement system captures
inpatient and day case activity (as weighted for case mix) per consultant and
reports on the level of private practice on a monthly basis.
x Where residual activity which is not yet captured by the HIPE system (e.g.
details of on-site private OPD activity and certain diagnostic activity) is being
collected manually by hospitals as an interim measure pending the
development of automated data collection systems.
x Each Consultant in the employment of the public health service –
irrespective of whether they hold Consultant Contract 2008 or not - should
be issued with a public private mix measurement report every month since
January 2009. This documents their activity in relation to inpatient, daycase,
outpatient and diagnostic activity over the previous three months. The report
is also issued to the relevant Clinical Director and Hospital Manager / CEO
for consideration and to facilitate action to ensure with Consultant Contract
2008.
x An overall status report is also prepared for internal HSE monitoring and
management purposes and monitoring. From the January 2009 reporting
period this report is considered as informing decisions by Clinical Directors
and managers on individual Consultant compliance on a contractual basis. It
will be provided monthly to the HSE Board, the Department of Health and
Children and will be available under FOI.
x There is an inevitable time lag (minimum of 4 months) in providing reports
due to the time required for coding activity from the patient charts.
A small number of hospitals are still dealing with data collection difficulties,
particularly with the reporting of on-site private OPD activity and diagnostics.
In this context, the HSE has instructed that - should Consultants engage in private
outpatient practice on campus such practice should, like all other public or private
activities undertaken on the public hospital campus, be subject to measurement as
part of the 80:20 / 70:30 ratio of public to private practice under Consultant
Contract 2008. Measurement includes co-located hospitals on campus, private
rooms on campus and private clinics on campus – with three exceptions. The
exceptions are the private outpatient practice of existing Consultants in private
clinics (as of 26th July 2008) on the campus of St James’, Beaumont and Cork
University Hospital.
Page 14 of 20
participate in competence assurance arrangements and provide education and
training to other clinicians.
The Contract also requires that new appointees to Consultant posts must now be
eligible for membership or have membership of the relevant division of the
Register of Medical Specialists maintained by the Medical Council. This means
that patients can be assured that Consultants meet the highest standards – both
when appointed and throughout their careers.
7. Teamworking
Under Consultant Contract 2008, Consultants must work as part of a team of
Consultants - this means that the Consultant provides diagnosis, treatment and
care to patients under the care of other Consultants on his/her Consultant team
and vice versa. This may include discharge and further treatment arrangements
thereby facilitating a more timely discharge of patients and speedier access of
patients into hospital.
Consultants are on-site for longer periods – meaning that there is a greater senior
clinical decision-making presence on-site. Key service enhancements can include:
Page 15 of 20
x Improvements in compliance with Hospital Accreditation, Medical
Records Audit, and Hygiene standards
The Contract requires that each Consultant will report to a Clinical Director who
ensures service standards and governance requirements are met; monitors and
manages public:private mix; develops and manages rosters (with an emphasis in
the short to medium term on move to an 8am – 8pm day and obtaining value
from the additional 4 hours per Consultant per week) and deals with grievances
and disputes, manages the initial stages of the disciplinary process, and helps
organise medical education and training.
The HSE is working with the Forum of Postgraduate Medical Training Bodies
and a number of sub-groups to develop the role of and support the work of
Clinical Directors
To date, 35 Clinical Directors have been appointed across the hospital system
from amongst those Consultants who accept Consultant Contract 2008. A
further 14 have been appointed in the Mental Health Services. Further Clinical
Director appointments will made over the next two years as services evolve. Up
to 77 appointments may be made in total. Appendix I refers.
An element of the HSE vote for 2009 was transferred to the Department of
Education and Science and subsequently to the HEA and the Universities to
fund the offer of Consultant Contract 2008 to Academic Consultants. The HSE
has no further involvement in the matter.
Page 16 of 20
In June, some of the Universities employing Academic Consultants began the
offer of Consultant Contract 2008 to those Consultants in their employment. At
7 July 2009, around 50% of Academic Consultants had accepted the terms of the
new contracts.
By July 2009, 1,688 consultants out of the 1,888 permanent consultants had
accepted the offer of Consultant Contract 2008. This represents an acceptance
rate of approximately 90%. The breakdown by Contract Type is as follows:
x Type A: 629
x Type B: 703
x Type B*: 356
In March 2008 the IMO and IHCA agreed to advertisement of Consultant posts
under Consultant Contract 2008. Following this agreement, the HSE approved
128 Consultant posts which were advertised by the Public Appointments Service
throughout April.
In the period up to 31st December 2008, a further 155 posts were approved – for
a total of 283 posts in 2008. 156 of these were new posts and 127 replacement.
This means that during the period March 2008 to September 2009 the HSE
approved 221 new Consultant posts and 195 replacement. This represents an
increase of 10.4% in the number of Consultant posts in an 18-month period.
There are now 2,342 Consultant posts in the Irish public health service.
Tables setting out the current distribution of Consultant posts and the
distribution of additional posts between March 2008 and September 2009 are set
out below:
Page 17 of 20
Obstetrics &
3 3 1 7
Gynaecology
Paediatrics 2 7 5 5 19
Pathology 6 2 5 8 21
Psychiatry 12 8 10 6 36
Radiology 12 8 7 8 35
Surgery 4 6 4 8 22
Total 66 54 46 55 221
The review examined all contracts issued and accepted by consultants employed
in the HSE and HSE funded agencies. Each contract was reviewed to identify
any alterations to the standard terms and conditions contained in the pro forma
contract agreed with the medical representative bodies in July 2008. The review
found:
Page 18 of 20
a) Appropriate standardised Contract documentation
Approximately half of the differential between the 1997 and 2008 salary rates was
to paid in 2009 as and from 1st January 2009. The original payment schedule had
identified the new rates for Consultants accepting the new contracts to apply
from the 1st June 2008. The other half scheduled for the 1st June 2009 was not
sanctioned and has not been sanctioned to date.
The HSE has no authority to make payments other than those approved by the
Minister for Health & Children.
Page 19 of 20
An Comhchoiste um Shláinte agus Joint Committee on Health and
Leanaí Children
Dáil Éireann Dáil Éireann
Teach Laighean Leinster House
Baile Átha Cliath 2 Dublin 2
Phone: (01) 618 3021
Fax (01) 618 4124
E-mail: sinead.mccann@oireachtas.ie
10th September 2009
You should note that Ms. Mary Harney, Minister for Health and Children has also
been invited to attend the meeting.
I will be in contact shortly with your Parliamentary Affairs Officials in regard to the
format of the meeting.
I would like to draw your attention to the fact that members of the Committee have
absolute privilege but this same privilege does not apply to witnesses appearing
before the Committee.
I would be grateful if you would confirm in writing whether you can attend the
meeting as soon as possible.
Yours sincerely,
__________________
Sineád McCann
Clerk to the Committee
Question 3 (national Question) CEO Only
To ask the Minister for Health and Children and the HSE Chief Executive for an
update on the Fair Deal (Nursing Homes Support Scheme Act 2009) scheme,
including details on: when it will commence, proposed changes to the scheme and if
negotiations have been completed with nursing home people etc.
The DOHC have indicated that they will be taking the response on this; however the following details on the
operationalisation/implementation of the scheme are relevant.
The Scheme
The Nursing Homes Support Scheme is a scheme of financial support for people in need of
nursing home care. The legislative basis for the scheme is the Nursing Homes Support
Scheme Act 2009. The Scheme is expected to commence in the last quarter of 2009.
Applicants to the scheme must undergo a care needs assessment to determine whether they
need nursing home care and a financial assessment to determine their ability to contribute
towards their own care. Based on the outcome of both these assessments, the HSE will
decide on the payment of financial support.
The scheme involves a co-payment arrangement between the person and the State.
Essentially, the person will contribute up to 80% of assessable income and up to 5% of the
value of any assets they own towards the cost of their care. The State will then pay the full
balance of the cost. It is important to note that a person will never pay more than the cost
of their care regardless of the level of their means.
The new scheme will replace the existing Nursing Home Subvention Scheme. The scheme
will be budget-capped.
1
Care Needs Assessment
A person or a family member/ guardian can apply to the HSE for an assessment of care
needs. The needs assessment will be carried out by healthcare professionals using a common
summary assessment record (CSAR), which is a document setting out a summary of the
applicant’s needs and the determination of care needs. If the applicant is assessed as needing
long term residential care, a decision can then be made in respect of the provision of
financial support under the scheme.
Financial Assessment
The Financial Assessment works out how much the applicant shall contribute to the cost of
their care by taking into account their income and assets.
The assessment will establish a person’s ability to contribute to their care costs based on
80% of their assessable income and 5% of the value of their assets, including their principal
residence. It contains safeguards to ensure that the spouse or partner remaining at home
keeps a minimum retained income. No one shall pay more than the agreed cost of care
applicable for the facility. The person’s principal residence will be excluded from the
financial assessment after 3 years from the date on which the person entered care including
time spent in care before the commencement of the Scheme. The person’s farm and
business may also be excluded from the assessment after 3 years in certain circumstances.
This means that the deferred contribution from such assets may in certain circumstances be
capped at a maximum of 15%, i.e. after three years of care, the applicant will not be liable for
any further contribution in respect of such assets.
Contribution to Care
During the applicant’s stay in long term residential care, they shall contribute the amount
determined in the financial assessment based on 80% of their assessable income and 5% of
the value of any cash assets (i.e. effectively savings) over the asset disregard per annum. The
annual contribution will be advised to the applicant in weekly terms also.
2
If their assessed means includes land and property, the 5% contribution based on such assets
may be deferred. This means it may not have to be paid during the person’s lifetime and
may be deferred (‘Deferred Contribution’) and collected from their estate. In order to
facilitate payment of the fees in such cases, a Nursing Home Loan/Ancillary State Support
will be provided by the HSE. This loan will be released to the nursing home on a weekly
basis. The applicant cannot assume that ancillary state support (the nursing home loan) will
be approved but must await formal notification of the outcome of the application. This
benefit is referred to as the Nursing Home Loan (“Ancillary State Support”) and must be
applied for.
This Deferred Contribution will be up to 5% of the value of certain chargeable assets per
year. It will apply only to each year of care and will be charged on a pro rata basis for any
period of care of less than one year. If there is a spouse or relatives (as defined in the Act)
living in the principal residence, the charge may be further deferred.
State Support
State Support will be provided as follows:
x For residents in a private nursing home, they will make their co-payment to the
nursing home and the State will meet the balance of the agreed cost of care to
provide the service
x For residents in public nursing homes, the State will collect their co-payment and
provide the service
x For residents in voluntary nursing homes, the voluntary agency will collect their co-
payment and the State will meet the balance of the agreed cost of care.
3
Care Representative
In order to benefit from the Nursing Home Loan, a person needs to consent to a Charging
Order being placed against the asset in question. The Charging Order is a simple type of
mortgage which provides the security for the loan advanced by the HSE. If a person is
found to lack capacity under the functional assessment, they will not be able to consent to
the creation of the Charging Order. For this reason, they will require a care representative to
act on their behalf.
The care representative must be appointed by the Circuit Court. Their role is set out in
section 21 of the legislation and is limited to:-
While the role of, and requirement for, the care representative is clearly limited to the actions
listed at (a) to (c) above, a care representative may assist an applicant to the scheme with any
matter in the same way that a non-court appointed representative may.
A care representative is required where a person lacks the capacity to make a decision in
relation to the matters listed at (a) to (c) above.
PCCC
Services for Older People
September 2009
4
Question 5 on National Issues – 7.10.09 – CEO’s File only
The Department of Health and Children will lead the response to this question.
The decision on whether and when to register and inspect facilities for children with
disability is for the Department of Health and Children, the Minister for Health and
Children and for HIQA. The HSE has no decision in this matter.
The HSE was co-operating with HIQA in developing standards for children's services which
will include residential services for children with disabilities. We are also working with HIQA
and DoHC on identifying the number and location of residential centres for children with
disabilities.
The timing of when centres will be inspected will be determined by HIQA and the DoHC.
Question 6 (National Issues) Symphysiotomy in Ireland (CEO’s File only)
x Medical assessment
x Gynaecological assessment
x Counselling
x Reflexology (GP to recommend)
x Physiotherapy (GP to recommend)
x Osteopathy (GP to recommend)
x Acupuncture (GP to recommend)
Independent clinical advice is available, on request, through the local liaison officer to
patients who have undergone symphysiotomy.
Applications for home help and home modifications are responded to on an individual basis
and applications fast tracked, if necessary. Clinical assessments and/or advice will be offered
to symphysiotomy patients where requested, including a home assessment by an
Occupational Therapist or Physiotherapist.
Once an individual patients condition has been confirmed they have automatic entitlement
to a medical card without a financial assessment being carried out.
Joint Oireachtas Committee for Health and Children
What protocols are currently in place to deal with people who present themselves at
psychiatric units with suicidal tendencies and if there are procedures in place to
contact the family of psychiatric patients when they are being discharged from
hospital.
Psychiatric Units accept referrals from Community Mental Health Teams and General
Practitioners. In some instances, clients self refer and in these circumstances staff perform
an assessment on the patient. If there are concerns in relation to the patient’s health, the
Consultant on call will undertake a psychiatric assessment and depending on the outcome,
invite the patient to stay if clinically indicated or offer an early appointment at an appropriate
community facility. These facilities may include an outpatient clinic, day hospital or follow
up home care.
With their expressed permission, family members and carers of the patient can be invited to
become involved in the care programme. This is the HSE preferred model and indeed is the
model recommended in “A Vision for Change” to work with, but this is dependent on the
agreement of the individual concerned. We are bounded by patient confidentially which we
must respect.
QUESTION
RESPONSE
The HSE is committed to extending and enhancing primary and community service
models as a preferred approach to providing care to mothers and babies with
uncomplicated pregnancies and treatment needs. We recognise the centrality of clinical
involvement and leadership in the design provision and improvement of care. The role of
the midwife is recognised as being fundamental to delivering women and baby-centred
maternity services.
The provision of maternity care is constantly evolving to respond to the changing needs of
women in Ireland and their families. The Primary Care Strategy (2001) highlighted the
need to develop national community midwifery schemes to align with the development of
primary care schemes nationally. Midwives provide care in maternity hospitals/units,
recently developed midwifery-led units and increasingly through the provision of
midwifery-led services in the community. Midwives work in partnership with obstetricians
and other members of the healthcare team in the provision of care, particularly to women
with complicated pregnancies.
The HSE has made a commitment in its Transformation Programme to develop its
strategic approach to Maternity Services nationally and this started in 2007 with the
Independent Review of Maternity & Gynaecology Services in the Greater Dublin Area.
The HSE/KPMG report on the Review of Maternity & Gynaecology services in the
Greater Dublin Area was published in February 2009 and is available on www.hse.ie. The
report is an integral blue print for maternity and gynaecology services. The review
provided an opportunity for organisations and individuals to debate and exchange ideas
for positive change maximising improvement for mothers and babies in terms of the
model of care and choice/safety agenda.
The report concluded that Dublin’s current model of stand alone maternity hospitals is not
the norm internationally. It is well recognised that for optimal clinical outcomes maternity
services should be located with adult acute services. This allows the mother to access a
full range of medical and support services should the need arise for (for example) cardiac
and vascular surgery, diabetes services, intensive care facilities, haematology services,
psychiatric services among others.
The development of co-located Midwifery led Units (MLUs) alongside obstetric units is a
key recommendation for the Greater Dublin Area. Pilot co-located MLUs were established
in 2004 in the North East area in Cavan General Hospital and Our Lady of Lourdes
Hospital in Drogheda and are still ongoing. These units are currently being evaluated by
the School of Nursing and Midwifery Trinity College Dublin and early indications are that
they are popular with women. Formal evaluation of these MLUs is imminent.
We are aware of the desire of all parties to progress the implementation of the
HSE/KPMG report recommendations and we are arranging to put in place appropriate
national, regional and local level supports for the work streams identified across service
redesign, workforce needs, clinical governance, teaching and training and physical
infrastructure requirements.
JOINT OIREACHTAS COMMITTEE
ON
and the
Since the 22nd July services have been centralised from Monaghan to Cavan as
part of the NE Transformation plan, a number of staff have been redeployed to
support the enhanced services in Cavan General – MAU, ICU, addition
ambulance personnel. To enable this in some instances there has been a direct
discipline specific transfer, however in other cases where a grade for grade
transfer has not been feasible posts freed up from the transfer of services are
being reconfigured and redeployed in the region to address identified quality and
risk issues. In particular the identified 50 priority Transformation posts to
address the following long standing priority objectives:
Page 1 of 17
x Meeting Birth Rate Plus best practice midwifery staffing levels at Cavan
General Hospital (CGH) and OLOL i.e. 1 midwife to every 37 births ( based
on 1,957 and 4,331 births respectively in 2008)
x Meeting British Association of Perinatal Medicine guideline for nurse staffing
in Neonatal Intensive Care within CGH (+2 ) and OLOL (+14)
x Moving towards Irish College of Obstetrics and Gynaecology standard of 1
Consultant obstetrician / gynaecologist to every 500 births ( 4th Consultant
CGH and 8th OLOL)
x Implementing FS report recommendations re 1 paediatric registered nurse on
each shift in ED at CGH and OLOL
x Progressing the initial strengthening of medical services in the areas of
Cardiac and the nurse manager for the Medical Assessment Unit
x Progressing the opening of the new ED Department at OLOL Drogheda
This analysis found that the there has been an overall decrease in daily
attendances at the Emergency Department by an average of 2 per day as patients
with medical needs are being treated in the Medical Assessment Unit (MAU)
which provides a more appropriate alternative for many patients who typically
attend Emergency Departments.
It also found that an average 1.5 extra patients are requiring admission per day
from the Emergency Department. The average number of patients waiting for
admission to a bed from the Emergency Department at 2pm each day has
increased slightly from 0.5 to 1, this anticipated rise in activity is catered for by
the extra capacity in the observation ward which accommodates all patients who
require observation for a period of 24 hours, and admission ward which
accommodates patients in an appropriate environment to await beds from the
time of decision to admit is made until an inpatient bed is available.
Page 2 of 17
2. The Future of the HSE services in the South East, particularly
St. Luke’s Hospital, Kilkenny and Wexford General Hospital.
The HSE future strategies for health service delivery are now proceeding to
implementation through the Transformation Programme. The aim is to
substantially align Irish health services with recognised international best practice.
The HSE is now seeking the implementation of these strategies across the South
East. Other factors including the cost of service provision and the
implementation of the European Working Time Directive for Non Consultant
Hospital Doctors will influence the implementation of HSE strategies.
A steering group was established in April 2009 to lead the project to plan and
implement the acute hospital transformation programme in the South East. The
title of the project is “Future Development of Acute Hospital Services”. In the
process of defining and planning the future Organisation of services the Steering
Group has established three Regional Specialty Advisory Groups to provide
specific advice and information on individual services. This advice / information
will advise the strategic plan for a revised model of care.
In this regard, no decisions regarding the roles of services of any hospitals will be
taken until this plan is completed through a process of broad based consultation
within the services.
It is anticipated that the role of the 4 hospitals in the South East including
Waterford Regional Hospital will change substantially in the future.
It is likely to be the end of 2009 before this review is completed. The review will
be published in the first quarter of 2010.
The RKW Consultants High Level Framework Brief for the new Paediatric
recommended, along with an ambulatory and urgent care centre on the Mater
campus, that the first such centre be developed at Tallaght Hospital. Many
parents who currently access urgent care type services at Tallaght, will be able to
continue accessing these services, but will do this via the new Ambulatory Centre
– a separate dedicated facility that will be constructed. Discussions have
commenced with management at AMNCH to cede a suitable site.
Page 3 of 17
4. To ask for confirmation of future plans for the delivery of cancer
services to the catchment area of Tallaght Hospital.
In relation to Symptomatic Breast Care Services, all new referrals to the AMNCH
Unit ceased on 31st August 2009. General Practitioners were informed of this by
both the NCCP and by the CEO of AMNCH. Referrals are now directed
towards St. Vincent’s and St. James’s Hospitals, the two Cancer Centre’s for the
Tallaght catchment area.
The NCCP and all three hospitals are now working together to manage the care
of current Tallaght patients. Appropriate arrangements will be made for their
ongoing care and follow up. Patients and GP’s will be communicated with if it is
necessary to transfer their care to St. James’s or St. Vincent’s. Medical Oncology
will continue to be provided in Tallaght for patients who prefer to avail of the
service closer to their home.
In the NCCP Service Plan there are plans to transfer other surgical services of
significant volume from Tallaght in the coming year. These are currently under
discussion. The next service likely to transfer will be pancreatic cancer which
affects a low number of patients (approximately 25 per year). It is anticipated
that this transfer will happen in January 2010. Rectal Cancer Surgery will also
transfer later in 2010 (approximately 40 cases per year).
Pancreatic cancer will move to St. Vincent’s University Hospital and Rectal
Cancer will move to St. Vincent’s University & St. James’ Hospitals.
The following is the position with regard to Dublin South West Primary,
Community & Continuing Care
Tallaght
Tallaght has a population of some 90,000 people and the profile is younger than
the national average. There are large pockets of social disadvantage and a large
immigrant community from African and Eastern European countries.
The HSE, either directly or through funded local organisations, provides a full
range of services to the people of Tallaght, including the full range of Primary
Care services, Child, Youth and Family Services, Disability Services, Older
Persons’ Services, Mental Health Services, social inclusion, and addiction services.
Page 4 of 17
Teams functioning or in active development in 2009:
Brookfield / Fettercairn (Tallaght west)
Killinarden / Oldbawn (Tallaght west)
Jobstown / Citywest (Tallaght west)
Springfield / Belgard (Tallaght west)
Cashel Road (Crumlin/Drimnagh)
Curlew Road (Crumlin /Drimnagh)
Old County Road (Crumlin / Drimnagh)
As of August 31st this year, a total of 80 WTEs have been reconfigured into
Primary Care Teams, The majority of these staff are Clinical (eg. Nurses,
Physiotherapists and Occupational Therapists etc).
The initial focus of development in this LHO area has been on the Tallaght west
Network, which has the highest profile of social disadvantage. Currently four
Primary Care Teams are in development to serve the communities of Jobstown-
Citywest, Brookfield-Fettercairn, Springfield-Belgard and Killinarden and the
Minister for Health and Children has agreed to open Community Information
Days for these teams before the end of November.
Strong links continue to be forged between Primary Care Team members and
voluntary and community groups working in the Tallaght West area, striving
towards an integrated approach to serving local communities.
A suitable premises was identified (Chamber House) by the HSE in the heart of
Tallaght to accommodate the social and care network services and the Springfield
Page 5 of 17
/ Belgard PCT and was included in the HSE Capital programme for 2009.
However due to the reduction in capital provision for this year it is not possible
to proceed with this development at this time.
Other sites in the Tallaght area, Kilnamanagh, Firhouse and Citywest are being
considered for primary care developments. These are being considered under the
term of the Public Private Partnership process. Negotiation in relation to some of
the sites is ongoing and subject to relevant approvals delivery of new sites is
expected in 2011 and 2012.
The existing health centre at Millbrook Lawns has been substantially refurbished
and was completed earlier this year to a high standard.
The HSE is chairing the multi-agency South Dublin Children Services Committee,
one of four pilots nationally being developed under the Towards 2016 Agreement.
This innovative project involves interagency cooperation involving all the main
agencies that impact on the lives of children, with a view to coordinating services
and working together to ensure best outcomes for their work.
The Knockmore Child and Family Centre, Tallaght, Dublin 24 is primarily a joint
venture between the HSE, South Dublin County Council and Barnardos. The
Child and Family Centre is part of the Knockmore Mixed Use Project, which is a
multi-agency, multi-use project enjoining the objectives of a number of
Government policies and departments. All elements of the project received the
requisite statutory approvals. The development of the Centre is on hold pending
the availability of capital monies from the various partners involved in its
development.
Page 6 of 17
The HSE participates in the RAPID developments across the area and is actively
involved in the work of local Drug Taskforces.
In the Tallaght area, the Belgard Road Treatment Centre provides a range of
treatment services including community alcohol services, assessment, nursing,
medical, counselling, psychiatry, treatment, dispensing, education, liaison
midwife, outreach and community welfare services. There is a specialised service
for under 18’s (YODA) based in Belgard Road. The team includes a Consultant
Child & Adolescent Psychiatrist, Registrar, Specialised Nurse, Counsellor and
Family Therapist.
The HSE provides wide range of services to adults who have mental health
difficulties with a strong emphasis on delivery of these services in the community
and the consequent reduction in dependency on institutional care. The Dublin
South West area is particularly well developed in this field where a significant
home care service is provided in the community.
6. To ask the Minister for health and Children if she will consider
appointing a Consultant Endocrinologist at Letterkenny
General Hospital.
Page 7 of 17
development of the service, the appointment of additional Consultant, Nursing,
Allied Health Professional and Administrative staff was approved and funded by
the NCCP.
To afford all patients across the South a high-volume quality service, the next and
final step in the centralisation of the symptomatic breast disease service is the
amalgamation of the Cork University Hospital (CUH), South Infirmary Victoria
University Hospital (SIVUH) and Mercy University Hospital (MUH) (Pathology)
breast disease services at Cork University Hospital by late 2009. To progress the
move, and to ensure wide-spread engagement and consultation, a joint
governance programme between NCCP, HSE, CUH, SIVUH and MUH has
been set up to afford all stakeholders, including frontline Consultant medical and
other clinical staff on the 3 sites, the opportunity to participate in the planning
and development of the service. This includes:-
In conjunction with this work, the following key infrastructural issues are being
addressed to ensure adequate capacity for the amalgamated service:-
x Radiology/Mammography/OPD capacity
x Inpatient and Day Bed requirements
x Theatre Capacity
x Pathology service
x Multidisciplinary meeting facilities and office accommodation
To support the Cork University Hospital Cancer Centre programme, NCCP has
provided capital funding of €5.750m set to develop an integrated diagnostic
centre which will accommodate the symptomatic breast service along with
planned rapid access clinics for lung, prostate and colo-rectal patients. This
funding will support the development of full diagnostic clinics and treatment
facilities and will significantly enhance cancer service provision within the South.
Revenue funding of €1.476m has been provided for additional posts of
Consultant in Radiology and Consultant Anaesthetist, along with support staff
for the Cancer Centre at CUH.
Page 8 of 17
x Contractual issues
x Patient care pathways
x Transfer arrangements
x Sessional commitments etc
and any issues that arise are being actively pursued and addressed. As part of this
process, a joint HR meeting was held with all relevant SIVUH Consultant
medical staff on Friday, 18th September, 2009 at the South Infirmary Victoria
University Hospital.
(a) Prepared a work plan which includes the development and embedding of
the usage of standardised breast cancer guidelines and referral forms.
They are progressing this via ongoing training days for GPs and other
health professionals (one was done in Cork in April)
(b) Developed and are putting in place clear and consistent patient pathways
that will enable cancer patients to continue to receive appropriate
elements of their treatment, care/after-care and support from their family
doctor, local hospitals and community services staff. They are working
with specialist services to examine the best way that patients with early
stage breast cancer can be followed up which includes the review of best
evidence in this regard and a draft protocol for follow-up of these
patients has been prepared. They are currently consulting with patients,
GPs and the specialist services in relation to protocol before finalising
this.
(c) Set up a Community Oncology Liaison Group, chaired by a Local Health
Manager from PCCC services in Cork, with GP representation on the
group.
The capital requirements in the South East are not the same as the North East.
While there is a requirement for a completely new hospital in the North East, this
is not the case in the South East. As no decisions have been made about the
future model of care in the South East it is premature to make any detailed
comment on Capital Infrastructure. This will be assessed as part of the planning
process and all factors will be taken into consideration before a final decision is
Page 9 of 17
made on the future organisation of services in the South East. The provision of
Health services in the South East will be continued in the existing hospital
facilities.
The vast majority of sick children are treated for discharge in the 4 hospitals in
the South East, thus avoiding unnecessary admissions to the 4 units. There is no
argument against this current model of ambulatory care. The Women and
Children’s Specialty Advisory Group is currently advising the Steering Group on
the future organisation of paediatric services.
10. Can the Minister provide an update on the Cystic Fibrosis unit
in St Vincent’s Hospital?
St. Vincent’s Hospital currently treats over 50% of the CF adult population.
The HSE is now working with St. Vincent’s to identify opportunities for patients
who do not require tertiary level care to be treated close to home where adult
services have been developed in the other specialist centres.
2.1.2 Infrastructure
x Eight new single en-suite rooms (St. Christopher’s Ward) for the in-
patient treatment of CF were opened at the hospital in August 2008.
This brings the total level of in-patient accommodation for the
treatment of respiratory patients (including people with CF) at the
hospital to 63 beds.
Page 10 of 17
x A new ward block to replace existing accommodation is being developed at
the hospital. This facility will provide single room en-suite inpatient
accommodation (100 rooms) and a dedicated day unit for people with CF,
including 10 single day treatment rooms with en-suite sanitary facilities. It is
intended that construction will commence in 2010 and the building will be
operational by mid 2011. Site clearance work has already commenced.
x The HSE is arranging to commence a contract for enabling and decant works
on site and is completing tender documents for the ward block in order to
ensure earliest possible commencement of construction in 2010. It expected
that the development will become operational in mid 2011
11. 1,100 medical card holders in the south of the country who are
seeking routine renewals have been turned down by the HSE
even though their economic circumstances haven’t changed or
in some cases have worsened – has a policy decision been
made to cut down on the number of medical card holders?
There has been no change in medical card assessment procedures in the HSE
South area. This area has been implementing the National Medical Card
(MC)/GP Visit Card (GPVC) Assessment Guidelines since they were introduced
in December 2005 (and updated in March 2007 & May 2009). The national
document gives very clear guidance on eligibility based on financial assessment.
The document also gives guidance on determining entitlement to persons whose
income exceeds the financial guideline i.e. where medical or other exceptional
circumstances may result in undue hardship.
From January to June this year, 93,114 applications for medical cards were
processed by the HSE South, with 80,977 approved and 11,228 refused. The
HSE also processed 13,345 applications for a GP visit card in that period,
refusing 2,892.
In addition cards have been reviewed throughout the year and the suggestion has
been made that a more onerous approach was being taken than in previous years.
Page 11 of 17
In this regard a comparison has been made between 2008 & 2009 and the
position is as follows:
In 2008, of the total number of cards reviewed in the South West (former SHB
area) 90.24% were granted cards with 9.76% being refused.
In 2009, of the total number of cards reviewed in the South West (former SHB
area) 88.64% were granted cards with 11.36% being refused. This represents an
increase of just only over 1% and does not reflect a significant change in the
approach to dealing with applications.
In 2008 In the South East (former SEHB area) the total cards reviewed 75%
were granted cards with 25% being refused.
In 2009 In the South East (former SEHB area) the total cards reviewed, 85%
were granted cards with 15% being refused. This represents a reduction in the
number of cases being refused in the South East.
The HSE trusts that the figures demonstrate overall how HSE South continues
to apply the medical card guidelines in a standardised way and continues to take
account of individual circumstances as heretofore.
Page 12 of 17
12. Could the Minister give an up to date statement on the
reconfiguration of acute hospital services in the Greater Cork
area involving Cork hospitals, Mallow and Bantry.
Establishment of subgroups
A total of 47 specialty and functional subgroups have been established. A chair
and project manager (in some cases two) have been appointed for each,
reporting templates have been issued, and arrangements have been made with
all six hospitals in the region and the HSE’s Performance Management Unit to
gather as much factual data as possible to inform the work of the subgroups. It
is hoped that most, if not all, of the subgroups will report back by the end of
October.
Each subgroup will include key members of its service delivery team, a patient
advocate representative, a PCCC representative, a representative from
University College Cork, a General Practitioner and a representative of each
hospital where the service is delivered and/or required. The subgroups are as
follows:
Page 13 of 17
Oncology
10. Clinical 29. Plastics
Haematology
11. Paediatrics 30. Maxillofacial &
primary dental
12. Palliative care 31.
Otorhinolaryngology
13. Radiology 32. Ophthalmology
14. Renal medicine 33. Urology
15. Rehabilitation 34. Vascular
medicine
16. Respiratory 35. Neuroscience
medicine (including
neurosurgery,
neurology)
17. Rheumatology 36. Gynaecology and
Obstetrics
18. Mental Health
19. Emergency
Services
Haemochromatosis testing
The Haemochromatosis subgroup was established early on to address the
specific issue of haemochromatosis testing. New protocols were developed that
allowed the introduction in recent weeks of an in-house testing regime at CUH
that replaced proposed outsourcing thereby creating significant savings to
patients and the taxpayer.
Page 14 of 17
Another recommendation is the establishment of special Medical Assessment
and Admissions Units in each hospital in the region. Dr Jennifer Carroll, a
consultant in the HSE South East who successfully introduced a similar Unit in
St Luke’s Hospital Kilkenny, is advising the Reconfiguration Forum on this
project. Quality standards and operating protocols will be introduced
throughout the region so that each unit provides similar levels of service to a
similar quality standard and each relates effectively to the hospital in which it is
based.
The Cork city hospitals, and Mallow General Hospital, will act collectively to
provide a co-ordinated emergency service for the city and for North Cork. This
will include a co-ordinated approach to bed management and the phasing out
of trolleys. In this respect, the recent publication of a strategic plan for the
Mercy University Hospital, is in line with the subgroup’s recommendations and
has been warmly welcomed by the Reconfiguration Forum.
The subgroup review deals at some length with the role of pre-hospital care in
an integrated emergency service, including potential enhanced roles for the
general public as first responders providing basic life support using Automatic
External Defibrillators (the Ambulance Service already has a programme
underway that has trained over 5,000 community first responders). Prof
Higgins has met with a wide range of political representatives and community
groups, and this engagement is ongoing.
Page 15 of 17
When the overall programme is completed, in Cork and Kerry there will be 82
primary care teams and 21 primary and social care networks – this will involve
a workforce of over 260 GPs working in teams with over 450 community
professionals i.e. nursing, physiotherapy, OTs, speech and language therapy &
social work staff across the region.
The teams will be supported through the 21 primary and social care networks
where over 4,917 staff will provide specialist services such as the 31 community
hospitals / residential centres for older people, which deliver over 1800 long
stay, rehabilitation and community support beds, 8 consultant geriatrician
teams, 30 day care centres for older people as well as 19 adult community
mental health teams and 7 child and adolescent teams.
All of these services will be linked together in a far more integrated way across
the community and linked to the acute hospital sector ensuring a more
seamless and responsive service for the public.
In relation to Southdoc I can confirm that they have been fully involved in this
overall process and the HSE south continues to liaise closely with them to
ensure that the services provided continue to meet the needs of the population.
Most recently Southdoc have extended their out of hours service in Cork City
to Saturday mornings commencing at 8.00 a.m. in response to increased service
needs.
Page 16 of 17