Written Answers Nos. 1522-1541
1522. Deputy Colm Burke asked the Minister for Health if he will give due consideration to expanding psychological support services to heart failure patients, currently available in only four hospitals in the State; and if he will make a statement on the matter. [56632/23]
View answerCurrent Cardiovascular Health programmes highlight the importance of cardiac rehabilitation which includes a psychological component. Psychological health and the presence of potential psychosocial risk factors are assessed for every patient as part of the initial assessment in cardiac rehabilitation. There are 36 centres providing cardiac rehabilitation services nationally. Where a clinical need is identified but the cardiac rehabilitation service has no direct access to psychology services, it is best practice to liaise with the patient’s General Practitioner to recommend that a referral to psychology services be made by the GP (HSE Model of Care for Integrated Cardiac Rehabilitation 2023).
Heart Failure is an important public health issue that affects approximately 90,000 in our population, it is a complex condition with increasing prevalence. The National Clinical Programme for heart failure is developed to improve quality of life for people living with the syndrome. The heart failure Model of Care for Ireland identifies the importance of psychological supports for those living with heart failure.
There has been significant investment in Integrated Care Programmes for Chronic Disease which includes heart failure. This investment has enabled the development of structures of care which will significantly improve all aspects of heart failure care, including psychological support. Within community settings, multi-disciplinary heart failure care is provided through each community specialist team, including access to a psychologist (HSE).
Importantly, the Government recognises and supports new initiatives in managing heart failure as a chronic condition. For example, promoting pioneering innovations like HeartCare at Home, a primary care project which is open to all people with heart failure in Ireland. To get heart failure specialist care to a wider cohort of patients ‘Virtual Consultation’ allows online, real-time discussion of heart failure case questions with a family doctor. This consultation results in very effective remote management, avoiding unnecessary referrals and travel for the patient and facilitates the sharing of specialist expertise.
Progress has been made in heart failure care, and to inform the next steps for this important work and to understand the challenges more, a National Review of our adult Specialist Cardiac Services, which includes heart failure, was commissioned. The Report has been presented to my office and is currently under consideration. The Review's recommendations will inform the future provision of cardiac services nationally including guidance on the priority needs for specialist roles such as psychologists.
1523. Deputy Colm Burke asked the Minister for Health if he will take the necessary steps to ensure that all heart failure patients are eligible for a medical card and to remove prescription charges, in light of the significant financial pressure faced by sufferers and the anxiety caused by a condition that results in the death of over one in three sufferers within five years; and if he will make a statement on the matter. [56633/23]
View answerMedical Card provision is primarily based on financial assessment. In accordance with the Health Act 1970 (as amended), eligibility for a medical card is determined by the HSE, which assesses each application on a qualifying financial threshold.
The issue of granting medical or GP visit cards based on having a particular disease or illness was previously examined in 2014 by the HSE Expert Panel on Medical Need and Medical Card Eligibility. The Group concluded that it was not feasible, desirable, nor ethically justifiable to list medical conditions in priority order for medical card eligibility. In following the Expert Group’s advice, a person’s means remains the main qualifier for a medical card.
However, every effort is made by the HSE, within the framework of the legislation, to support applicants in applying for a medical card and, in particular, to take full account of the difficult circumstances in the case of applicants who may be in excess of the income guidelines. The HSE may exercise discretion and grant a medical card, even though an applicant exceeds the income threshold where they face difficult financial circumstances, such as extra costs arising from an illness. Social and medical issues are also considered when determining whether undue hardship exists for an individual accessing general practitioner or other medical services.
The HSE also has a compassionate system in place for the efficient provision of medical cards in response to emergency situations i.e., where persons are in need of urgent ongoing medical care or when a patient is receiving end of life treatment. In these cases, a medical card is issued within 24 hours of receipt of the required patient details and completed medical report by a healthcare professional. In addition, since March 2021, persons who have been certified by their treating Consultant as having a prognosis of 24 months or less are now also awarded a medical card on an administrative basis. Medical cards awarded on end-of-life grounds are never re-assessed by the HSE thereby providing reassurance and comfort to patients and their families.
Since 2022, under the Drugs Payment Scheme (DPS), no individual or family pays more than €80 a month towards the cost of approved prescribed medicines. The DPS is not means tested and is available to anyone ordinarily resident in Ireland. The DPS significantly reduces the cost burden for families and individuals with ongoing expenditure on medicines. Individuals may also be entitled to claim tax relief on the cost of their medical expenses, including medicines prescribed by a doctor, dentist, or consultant. Relief is at the standard tax rate of 20%.
Medical card holders under the age of 70 years, are charged a prescription charge of €1.50 for each item. This is up to a maximum of €15 per month, for each person or family. Medical card holders over 70 years of age, are charged a prescription charge of €1.00 for each item. This is up to a maximum of €10 per month, for each person or family.
This Government has put a significant focus on improving access to and the affordability of healthcare services, advancing substantial policy, legislation and investment to deliver expanded eligibility. I can assure the Deputy that, to ensure the medical card system is responsive and sensitive to people's needs, my Department keeps medical card issues, including prescription charges, under review and any changes are considered in the context of Government policy, annual budgetary estimates process and other issues which may be relevant.
1524. Deputy Colm Burke asked the Minister for Health if he will allocate funding for the investment in practical, social and emotional supports in the community for heart failure patients for the purposes of reducing readmissions and improve quality of life for same, given that such community supports currently do not receive any statutory funding and should be recognised as an integral part of heart failure services and included in the HSE'S Model of Care; and if he will make a statement on the matter. [56635/23]
View answerAs the Deputy's question relates to HSE matters, I have arranged for the question to be referred to the HSE: National Clinical Programme for Heart Failure, Enhanced Community Care and Chronic Disease Management for direct reply to the Deputy.
1525. Deputy Colm Burke asked the Minister for Health if he will arrange for his Department and the HSE to undertake a full assessment of the economic impact of heart failure on patients; and if he will make a statement on the matter. [56636/23]
View answerThe HSE Heart Failure Clinical Programme is focused on improving all stages in the prevention and treatment of heart failure. It is one of several chronic disease management programmes established in the HSE aimed at bringing a systematic approach to changes in how services are delivered to improve outcomes for patients. Economic evidence highlights that heart failure places a major demand on healthcare spending and can account for an estimated 2-4% of the total healthcare budget (HSE National Heart Failure Clinical Care Programme)
Heart failure is high on the health services agenda. Since the establishment of the HSE Heart Failure Clinical Programme in 2012, approaches to heart failure have improved. The National Heart Failure Clinical Programme has carried out a significant amount of important work for patients living with heart failure. Ireland’s wider community of clinical practice in heart failure has provided leading research and innovation that continues to inspire the world. The STOP-HF project for example is a dedicated heart failure prevention strategy. This first-of-type concept has been proven to be successful and has resulted in changes in international guidelines. Ireland is among the world leaders in developing strategies to prevent heart failure.
Ireland is promoting pioneering innovations like the HeartCare at Home, a primary care project, which is open to all people with heart failure in Ireland. To get heart failure specialist care to a wider cohort of patients ‘Virtual Consultation’ allows on-line, real-time discussion of heart failure case questions with a family doctor. This consultation results in very effective remote management, avoiding unnecessary referrals and travel for the patient and facilitates the sharing of specialist expertise. This service was first developed along the East Coast of Ireland and Carlow and is now being rolled out nationally through the Health Service Executive integrated care programme for chronic illness.
While no formal assessment of the economic impact of heart failure has been undertaken, the National Programme clinical leads, in collaboration with the Irish Heart Foundation, among others, undertook a "cost-to-state" analysis in 2015. It sought to help identify problem areas in heart failure prevention and treatment within the community as well as areas where spending can be increased to better serve the patient and healthcare professionals.
1526. Deputy Michael Ring asked the Minister for Health if a matter in relation to veterinarians (details supplied) will be addressed considering the impact this will have on approved slaughterhouse establishments under local authority supervision; and if he will make a statement on the matter. [56663/23]
View answerAt present, Local Authorities (LAs) under service contract with the Food Safety Authority of Ireland (FSAI) are responsible for food law enforcement at certain food businesses, including small meat manufacturing plants and slaughterhouses.
On 3rd January 2024, the Department of Health (DoH), Department of Agriculture, Food and the Marine (DAFM), Department of Housing, Local Government and Heritage (DHLGH), and the FSAI signed a Memorandum of Understanding (MoU) confirming that DoH, DAFM and FSAI, in consultation with DHLGH, have reached an ‘Agreement in Principle’ for the State to have a single National Veterinary Service in terms of the function relating to the supervision of food production premises, that incorporates the Local Authority Veterinary Service (LAVS) into the existing DAFM Veterinary Service.
Understanding the significant complexities involved in progressing the transfer of the LAVS to DAFM, the parties have agreed to develop a phased transitional plan, which will be in consultation with the local government sector.
As the existing LAVS contracts between the LAs and FSAI were due to expire on 31st December 2023, the LAs signed extended contracts with FSAI for the continued delivery of the LAVS up until end February 2024. The extended contracts will allow for the development of a phased plan, including a work programme with agreed timeframes for the transfer of functions that fall within the scope of the Agreement.
Subject to Government approval and agreement of the phased plan, the contracts will then be further extended to facilitate implementation of the work programme. The LGMA has already met with Fórsa, the Union representing the Veterinary Inspectors. There will be further engagement with the Local Authority Veterinary Inspectors as this process progresses.
It is the intention of the relevant parties that the official controls will continue without disruption to the businesses and without any reduction in consumer protection.
1527. Deputy Mattie McGrath asked the Minister for Health the current plans for a building (details supplied) which is currently vacant and owned by HSE; and if he will make a statement on the matter. [56664/23]
View answerAs the Health Service Executive is responsible for the management of the public healthcare property estate, I have asked the HSE to respond directly to you in relation to this matter
1528. Deputy Paul Murphy asked the Minister for Health further to Parliamentary Question No. 189 of 6 December 2023, if he is aware that the National Gender Service is actively advising GPs not to provide blood tests and prescribe hormone therapy to trans patients, which has led to GPs denying these essential gender-affirming medical services to their patients. [56669/23]
View answer1529. Deputy Paul Murphy asked the Minister for Health further to Parliamentary Question No. 189 of 6 December 2023, if he will send a circular to GPs to clarify that GPs should provide blood tests and hormone therapy (details supplied). [56670/23]
View answer1530. Deputy Paul Murphy asked the Minister for Health further to Parliamentary Question No. 189 of 6 December 2023, his views on whether in line with the WPATH SoC v8 statement (details supplied) that all GPs should be providing blood tests to trans people who are self-medicating. [56671/23]
View answer1531. Deputy Paul Murphy asked the Minister for Health further to Parliamentary Question No. 189 of 6 December 2023, his views on whether there are no legal or medical obstacles preventing GPs from providing blood tests to their trans patients. [56672/23]
View answerI propose to take Questions Nos. 1528, 1529, 1530 and 1531 together.
GPs are private practitioners, most of whom hold contract(s) with the HSE for the provision of health services, such as under the GMS scheme for the provision of health services without charge to medical card and GP visit card holders. Clinical determinations are made by the GP concerned.
The HSE has identified the need to develop an updated and integrated Model of Care for transgender services in Ireland, informed by the best evidence-based clinical care for individuals who express gender incongruence or dysphoria and will look at the whole patient journey including primary care.
As this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
1532. Deputy Paul Murphy asked the Minister for Health further to Parliamentary Question No. 189 of 6 December 2023, at what stage and in what form will the HSE consultation take place with a wide range of stakeholders in the development of the new model of care; including those who use the services and advocacy groups; and if trans groups will have any decision making power. [56673/23]
View answerAs the Clinical lead in the HSE will be running this MOC I am referring to them for response
1533. Deputy Paul Murphy asked the Minister for Health if he is aware that the National Gender Service has a model of care which did not go through any clinical design approval or governance structure in the HSE, and nor is its acceptance a process that happened within his Department (details supplied). [56674/23]
View answerThe Government is committed to the development by the HSE of a well-governed and patient-centered health care service for adults and children in the transgender community, in line with the Programme for Government.
The HSE National Quality and Patient Safety Directorate has reviewed the interim Cass report and how it applies to clinical pathways in Ireland. The Department welcomed this review of the interim Cass report, and has considered its implications. The Department also understands that based on the recommendations of this report, the HSE has identified the need to develop an updated and integrated Model of Care for transgender services in Ireland, informed by the best evidence-based clinical care for individuals who express gender incongruence or dysphoria.
The HSE is establishing a team to lead the development an updated model of care for the treatment of gender dysphoria. As an initial step, the HSE has advertised for the post of Clinical Lead for Transgender Services, who will develop the Model of Care and Implementation Plan for Transgender Care.
The HSE will consult with a wide range of stakeholders in the development of the new model of care, including those who use the services and advocacy groups.
The HSE is also working to identify an alternative pathway for children/young people experiencing protracted waiting times. Discussions are underway with the paediatric endocrinology service at Children's Health Ireland and also with a psychology service to work on an interim solution until a full dedicated multidisciplinary service is established. In treating children and young people, any decision is a clinical matter for the treating clinician, their patient and family.
I welcome the development of a model of care which will deliver a high quality seamless and integrated service for people with gender identity issues, in line with the Programme for Government.
In relation to the clinical, service and operational matters, I have referred this PQ to the HSE for them to reply directly also.
1534. Deputy Paul Murphy asked the Minister for Health the basis on which the National Gender Service has national in its name; and if this name was approved by the HSE or his Department. [56675/23]
View answerAs this refers to a service, I am referring to the HSE for direct reply
1535. Deputy Paul Murphy asked the Minister for Health the estimated cost of a clinic (details supplied); and when the new location will begin operation. [56676/23]
View answerAs this refers to a service matter, I am referring to the HSE for direct response.
1536. Deputy Paul Murphy asked the Minister for Health what consultation was performed with the trans community before approving the funding for a service (details supplied). [56677/23]
View answerAs this relates to a service matter, it has been referred to the HSE for direct response.
1537. Deputy Paul Murphy asked the Minister for Health what reduction from the current over ten-year waiting list for the National Gender Service he expects to result from a new clinic (details supplied). [56678/23]
View answerAs this is a service matter I am referring to the HSE for response
1538. Deputy Paul Murphy asked the Minister for Health further to Parliamentary Question No. 617 of 24 October 2023, to outline the rationale to exclude operations carried out on adults at Cappagh Hospital from the external review. [56692/23]
View answer
The independent, overarching external review was commissioned to review the service, including the governance, being provided by the Paediatric Orthopaedic Surgery Service at CHI Temple Street, CHI Crumlin, the National Orthopaedic Hospital, Cappagh and other relevant sites in Dublin. It is my understanding that the review does not include operations carried out on adults as the review is focused on paediatric services.
The final Terms of Reference for the review are available here: www.hse.ie/eng/services/news/newsfeatures/tor-for-review-of-the-paediatric-orthopaedic-surgery-service-at-chi/terms-of-reference-for-the-review-of-paediatric-orthopaedic-surgery-service-at-chi-and-dublin-hospitals.pdf
1539. Deputy Peadar Tóibín asked the Minister for Health the total number of adverse incidents reported to the State Claims Agency which related to the Health Regulation of Termination of Pregnancy Act 2018 in each of the past five years and to date in 2023; the details of the outcomes of claims taken against the State in relation to the Act; the number of claims settled or ongoing; and if he will make a statement on the matter. [56712/23]
View answer1540. Deputy Peadar Tóibín asked the Minister for Health the number of persons who are taking or have taken cases against the State alleging that their unborn baby was wrongfully diagnosed and subsequently aborted; the number of claims notified to the State Claims Agency; and the number of cases ongoing and the number of cases which have been settled. [56713/23]
View answerI propose to take Questions Nos. 1539 and 1540 together.
The State Claims Agency (SCA) has a statutory remit to manage personal injury claims on behalf of Delegated State Authorities including the Health Service Executive.
I have been informed by the SCA that 150 incidents have been reported to the Agency from 01/01/2018 to 20/12/2023 relating to Termination of Pregnancy.
Table 1 - Termination of Pregnancy Incidents reported per year
|
Incident Reported Year |
2018 |
2019 |
2020 |
2021 |
2022 |
2023 |
Grand Total |
|
Number of Incidents |
2 |
27 |
36 |
33 |
28 |
24 |
150 |
The SCA has two ongoing claims from persons alleging that their unborn baby was wrongfully diagnosed with a condition sufficient to bring them within the scope of the Health Regulation of Termination of Pregnancy Act 2018. It is inappropriate to provide the years of claims, as to do so could have the effect of identifying individual cases.
1541. Deputy Peadar Tóibín asked the Minister for Health the total number of adverse incidents reported to the national incident management system which related to termination of pregnancy in each of the past five years and to date in 2023. [56714/23]
View answerAs the Deputy's question relates to a service area I have referred it to HSE for direct reply.
