Written Answers Nos. 526-542
526. Deputy Fergus O'Dowd asked the Minister for Health if he will seek information on whether the audit tool as referenced in a response from the HSE (details supplied) has been completed and put in place by the national dementia office; and if he will make a statement on the matter. [7439/24]
View answerAs this is an operational matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
As the Deputy may be aware, management and administrative grade staff in the Fórsa union in the HSE commenced industrial action on Friday, 6 October. As a consequence of this industrial action, members in these grades are not engaging with political forums or processes. As a result, the question asked by the Deputy may be delayed in receiving a response directly from the HSE.
527. Deputy Ged Nash asked the Minister for Health the status of the draft design guide for long-term residential care settings for older people, recently published by his Department in conjunction with HIQA and the HSE, with particular reference to the proposition to cap future nursing homes at 85 beds; if he will provide the policy rationale for such a move; if he is aware of concerns in the sector that this may result in a cessation of provision of new nursing homes, due to economies of scale; and if he will make a statement on the matter. [7472/24]
View answerLong-term residential care remains a crucial part of the continuum of care for older people and it is vital that the built environment and location of residential care settings support high quality care and positive experiences for our older population.
I therefore committed to creating new design standards for long-term residential care settings for older people (inclusive of the public, private, and voluntary sector), which will articulate best practice in design across the sector and will provide a common benchmark against which standards can be measured. High-quality design, planning, and construction is vital in creating safe environments that enable high quality care. The new design guidelines will apply to the building, extension, and conversion of long-term residential care settings for older people.
This work was progressed by the Department of Health, in conjunction with the Health Service Executive (HSE), and the Health Information and Quality Authority (HIQA). Following the publication of the design guide, the Chief Inspector within HIQA will support those seeking to deliver long-term residential care services for older people by offering a pre-application registration advice process prior to an application for planning permission from a Local Authority.
On 19 December 2023, I announced a new public consultation on the Design Guide for Long-Term Residential Care Settings for Older People, which closed on 15 February 2024. The public consultation allowed the Department of Health to hear the views of a wide range of stakeholders and the feedback received, which is currently under review, will inform the final version of the design guide.
528. Deputy David Cullinane asked the Minister for Health if he will address concerns raised regarding the health centre in Collooney (details supplied); and if he will make a statement on the matter. [7473/24]
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.
As the Deputy may be aware, management and administrative grade staff in the Fórsa union in the HSE commenced industrial action on Friday 6th October. As a consequence of this industrial action, members in these grades are not engaging with political forums or processes. As a result, the question asked by the Deputy may be delayed in receiving a response directly from the HSE.
529. Deputy Michael Lowry asked the Minister for Health when the guideline and calculations used to assess the qualification for the under-70s medical card was last reviewed; how can it be justified and deemed equitable that the basic allowance for a couple to qualify for a full medical under-70s medical card still stands at €266.50 per week, when the rate of jobseeker’s allowance for a couple is €386.00 per week; and if he will make a statement on the matter. [7496/24]
View answerEligibility for a Medical Card is primarily based on a financial assessment which is conducted by the HSE in accordance with the Health Act 1970 (as amended). The HSE assesses each medical card application on a qualifying financial threshold. This is the amount of money that an individual can earn a week and still qualify for a card. It is specific to the individual’s own financial circumstances.
Persons aged 70 or older are assessed under medical card income thresholds which are based on gross income. The weekly gross medical card income thresholds for people aged 70 and over are currently €550 per week for a single person and €1050 for a couple.
Persons under 70 are assessed under the general means tested medical card thresholds which are based on an applicant’s household income after tax and the deduction of PRSI and the Universal Social Charge. Certain expenses are also taken into account. Examples of allowable expenses include rent, mortgage, certain insurance costs, childcare, maintenance, nursing home net costs which help to increase the amount a person can earn and still qualify for a medical card. For people under 70, the thresholds range from €184 per week for a single person living alone aged under 66, to €298 per week for married, cohabiting couple or a single parent family aged over 66 (with additional amount for each child dependant). Detailed guidelines are available at: Assessment for a medical card - HSE.ie.
Every effort is made by the HSE, within the framework of the legislation, to support applicants in applying for a medical card - in particular, to take full account of difficult circumstances in the case of applicants who may be in excess of the income guidelines. In such circumstances, the HSE may exercise discretion and grant a medical card, for example:
• Discretionary medical cards issued to patients with significant medical expenses but who do not satisfy the means test.
• Emergency medical cards are issued to patients that are terminally ill, or are seriously ill, and in urgent need of medical care that they cannot afford.
• Medical cards issued to patients who are terminally ill with a prognosis of 24 months or less do not require subsequent means assessment and are not reviewed.
• As of 1st January 2024, 1,611,187 persons hold eligibility for a medical card, of which 184,624 cards are provided on a discretionary basis.
• As of 1st January 2024, 630,474 hold eligibility for a GP Visit Card, of which 39,244 cards are provided on a discretionary basis.
Furthermore, the expansion of GP visit card eligibility to all people who earn up to the median household income has resulted in increase in the qualifying weekly financial thresholds for a GP visit card. Over 400,000 additional persons, who otherwise would have attended their GP on a private basis, are expected to become eligible for free GP care under this expansion.
To ensure the medical card system is responsive and sensitive to people's needs, my Department keeps medical card issues under review and any changes are considered in the context of any potential broader implications for Government policy, the annual budgetary estimates process and legislative requirements arising.
530. Deputy Paul Murphy asked the Minister for Health when will Government funding be available for public IVF; and if he will make a statement on the matter. [7497/24]
View answerAs the Deputy may be aware, a commitment to “introduce a publicly funded model of care for fertility treatment” is included in the Programme for Government.
The Model of Care for Fertility was developed by the Department of Health in conjunction with the HSE’s National Women & Infants Health Programme (NWIHP) in order to ensure that fertility-related issues are addressed through the public health system at the lowest level of clinical intervention necessary.
This Model of Care comprises three stages, starting in primary care (i.e., GPs) and extending into secondary care (i.e., Regional Fertility Hubs) and then, where necessary, tertiary care (e.g., IVF and ICSI (intra-cytoplasmic sperm injection)), with patients being referred onwards through structured pathways.
Phase One of the roll-out of the Model of Care has involved the establishment, at secondary care level, of Regional Fertility Hubs within maternity networks, in order to facilitate the management of a significant proportion of patients presenting with fertility-related issues at this level of intervention. Patients are referred by their GPs to their local Regional Fertility Hub, which provides a range of secondary treatments, and both medical and surgical interventions.
Phase Two of the roll-out of the Model of Care relates to the introduction of assisted human reproduction (AHR) treatment provided through the public health system at tertiary level. In particular, the first steps have been taken towards achieving the ultimate objective of Government, which is a wholly publicly-provided fertility service.
As an interim measure, funding has been made available to support access to AHR treatment via private providers from September 2023. As well as IVF and ICSI, this allocation is also being used to provide, initially through private clinics, IUI (intrauterine insemination), which can, for certain cohorts of patients, be a potentially effective, yet less complex and less intrusive treatment.
Referrals for AHR treatment by private providers commenced in the week beginning September 25th 2023 after details of how the new initiative would be initially rolled out – including regarding the set of criteria which prospective patients should meet in order to access fully-funded AHR services and the specific services to be initially funded – were agreed by the Department and NWIHP and then brought to Cabinet in July 2023. The criteria were developed and finalised further to engagement and consultation with experts in the field of reproductive medicine, with the clinical parameters of the access criteria including the assessment of such areas as age, body mass index (BMI) and other health and well-being elements.
These clinical parameters were reviewed in the context of both the potential success or otherwise of the advanced fertility treatment itself but also the health and well-being of the intending birth mother and any resultant pregnancy inclusive of the management of maternity care, delivery and health of any child. The approach adopted by the Department of Health in relation to defining clear parameters regarding specific clinical criteria for AHR is in line with many European and international counterparts, allowing for necessary accountability for the cost-effectiveness use of public funds and the safety of patients and any consequent pregnancy that may result. More details on public fertility services generally, including information on the new publicly-funded AHR treatment initiative, are available from the HSE at: www2.hse.ie/conditions/fertility-problems-treatments/fertility-treatment/
The access criteria and the scheme generally will be kept under review as new evidence becomes available, an understanding of how the service provision is working in practice emerges, and when the AHR legislation – currently at Committee Stage in the Dáil – is finalised.
It is important to note that a defined list of fertility medicines needed for fertility treatment is covered under the High Tech Arrangements administered by the HSE. Medicines covered by the High Tech Arrangements must be prescribed by a consultant/specialist and authorised for supply to the client’s nominated community pharmacy by the High Tech Hub managed by the Primary Care Reimbursement Service. The cost of the medicines is then covered, as appropriate, under the client’s eligibility, i.e., Medical Card or Drugs Payment Scheme. Given the costs associated with certain fertility medicines, I understand that these schemes can have a material impact on the total cost of AHR treatment for individuals who avail of them. In this regard, according to figures from the HSE, a total of over €40m was spent on what it termed as fertility drugs in 2022.
In addition, there is other support available in that patients who access IVF, or other advanced AHR treatment, privately may claim tax relief on the costs involved under the tax relief for medical expenses scheme.
My Department and the Government are focused, through the full implementation of the Model of Care for Fertility, on ensuring that patients receive care at the appropriate level of clinical intervention and then those requiring, and eligible for, advanced AHR treatment such as IVF will be able to access same through the public health system. The underlying aim of the policy to provide a model of funding for AHR, within the broader new AHR regulatory framework, is to improve accessibility to AHR treatments, while at the same time embedding safe and appropriate clinical practice and ensuring the cost-effective use of public resources.
531. Deputy Aengus Ó Snodaigh asked the Minister for Health what action has his Department has taken to ensure the HSE pays the €17.03 million owed to Dublin City Council for the ambulance service provided by Dublin Fire Brigade; and if he will make a statement on the matter. [7537/24]
View answerDublin Fire Brigade (DFB) provides emergency ambulance services in Dublin city and county by arrangement between Dublin City Council (DCC) and the Health Service Executive (HSE). The National Ambulance Service (NAS) also provides some emergency capacity within the greater Dublin area.
In relation to funding for DFB ambulance services, the HSE makes an annual financial contribution towards the operation of emergency ambulances in Dublin. The basis for this arrangement is rooted in the recommendations of the 1993 Review of Ambulance Services in Ireland.
In the interests of interoperability and procurement economies of scale, the HSE has in recent years also directly provided for the capital replacement of DFB emergency ambulances.
I have asked the Health Service Executive to respond to the Deputy with any further pertinent information it may have concerning the Deputy's specific query, as soon as possible.
532. Deputy Claire Kerrane asked the Minister for Health further to Parliamentary Question No. 319 of 9 November 2023, the number of active dentists on the dental scheme for medical card holders in both counties or if there are none; and if he will make a statement on the matter. [7539/24]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly.
533. Deputy Michael McNamara asked the Minister for Health how many palliative care beds are currently operational at Raheen, Community Hospital, County Clare; and if he will make a statement on the matter. [7557/24]
View answerAs this is an operational matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
As the Deputy may be aware, management and administrative grade staff in the Fórsa union in the HSE commenced industrial action on Friday, 6 October. As a consequence of this industrial action, members in these grades are not engaging with political forums or processes. As a result, the question asked by the Deputy may be delayed in receiving a response directly from the HSE.
534. Deputy Robert Troy asked the Minister for Health the progress on reforms regarding the serious concerns surrounding Children and Adolescent Mental Health Services (CAMHS) which have been reported repeatedly for years (including both the very concerning review of CAMHS in the Mental Health Commission and Maskey reports) and yet families across Ireland have seen no urgent action or prioritisation of reform, 22,000 children referred to CAMHS each year continue to be failed as a result. [7561/24]
View answerI firmly support the regulation of all mental health services, including community CAMHS, and I have been progressing priority legislation to underpin this regulation.
The Government recognises the importance of ensuring all mental health services, both inpatient and community, and both adult and child and adolescent, are fully registered, regulated, and inspected by the Mental Health Commission in its role as the independent regulator of mental health services.
Under the Mental Health Act 2001, the Mental Health Commission registers, inspects, and regulates all inpatient mental health services, including inpatient CAMHS. The current Mental Health Act 2001 does not include any provisions for the registration or regulation of community mental health services and therefore, it is not considered that the Act provides the necessary legal basis to expand the Commission’s regulatory remit.
The expansion of the Mental Health Commission’s role into regulating all community mental health services, including community CAMHS, is being addressed in the forthcoming Mental Health Bill. This new Bill is a complex and lengthy piece of legislation. It will provide the necessary legal underpinning to ensure that the Mental Health Commission can regulate all community services. Additionally, the Bill will overhaul the involuntary admission and detention process, modernise provisions related to consent to treatment, provide enhanced safeguards for people accessing inpatient treatment, and provide a new, discrete Part that relates exclusively to the care and treatment of children and young people.
Drafting of this Bill has been prioritised and it is now in its final months of drafting. It will be introduced to the Oireachtas in the summer legislative session, which begins in April.
Work also continues to improve CAMHS at service level. Year-on-year funding for mental health services increased by €74 million from €1.221 billion in Budget 2023 to nearly €1.3 billion in 2024, and with a strong focus on investing in child and youth mental health. This is the fourth consecutive year of an increase for mental health services, and highlights in real terms the importance this Government places on the mental health of those living in Ireland.
CAMHS receives €146.5 million in dedicated funding annually. In addition to this, approximately €110 million in funding is provided by the Government to community-based mental health organisations and NGOs each year to deliver supports and services. A significant proportion of this is dedicated to supporting young people. I recently announced a further €10 million in funding for mental health to support the delivery of clinical programmes and youth mental health. This again highlights the Government’s recognition of mental health as a central component to overall health, and to reform youth mental health care in line with the policies Sharing the Vision and Connecting for Life.
For the first time in the history of the State we now have a dedicated National Office for Child and Youth Mental Health in the HSE. This is a very significant development which I delivered and it will improve leadership, operational oversight, and management of all service delivery and improvements. Both a new HSE National Clinical Lead for Child and Youth Mental Health and a new HSE Assistant National Director for Child and Youth Mental Health have recently taken up post.
There continues to be growing demand for CAMHS across the country with over 22,000 referrals last year. Between 2020 and 2021, referral rates into CAMHS increased by 33%, while the number of new cases seen increased by 21%.
It is acknowledged that there is a variation of referral acceptance across CAMHS teams, and this is an area being prioritised by the HSE to help improve access to CAMHS and to address CAMHS waiting lists. The HSE is taking account of the recent Maskey and Mental Health Commission reports on CAMHS, and is currently finalising a Youth Mental Health Service Improvement Plan which will set out agreed actions for focused service improvement through identified, timely, and measurable actions.
All CAMHS teams have worked closely with the Mental Health Commission over the last year or so to develop and implement improvement plans as needed following the Interim and Final Reports of he Commission on CAMHS nationally.
In addition, the HSE continues to progress three national audits in relation to CAMHS arising from the Maskey Report on South Kerry. These were the national review of CAMHS prescribing practice and the national audit of compliance with the CAMHS Operational Guidelines, both of which were recently published. In addition, a qualitative review of service user experiences is being undertaken by UCC. These reports will be given full and proper consideration by the Government.
There are 75 CAMHS teams and 4 in-patient units nationally. Staffing in community CAMHS has increased in recent years, with an increase of 500 full time equivalent posts between 2011 and 2024. I secured funding for additional new posts under Budget 2024, with a focus on child and youth mental health posts.
CAMHS is a specialist service and can only accept children or adolescents where there is evidence of a moderate to severe mental health difficulty present. Access to CAMHS is detailed in the HSE Clinical Operational Guidelines which sets out the core functions and remit of CAMHS and indicates referral pathways to this specialist service. As such, CAMHS is not suitable for children or adolescents whose difficulties primarily are related to learning problems, social problems, behavioural problems, or mild mental health difficulties.
Evidence shows that only 2% of children and young people need the support of the specialist CAMHS multidisciplinary teams. Access is on the basis of prioritised clinical assessment and all referrals to CAMHS are assessed by a multidisciplinary team.
It is important to state that there continues to be growing demand for CAMHS, with the 75 community teams nationally delivering around 225,000 appointments for children and young people annually. The expected activity under the HSE National Service Plan 2024 projects CAMHS referrals received of approximately 23,000, with around 13,700 of these referrals expected to be seen by CAMHS in line with operational guidelines. CAMHS teams, along with the wide range of other youth mental health supports provided by or on behalf of the HSE, make a crucial and real difference to the lives of many vulnerable young people, and their families, each year.
The Deputy can rest assured that I, and the Government, remain fully committed to the development of all aspects of mental health services nationally.
535. Deputy Brendan Griffin asked the Minister for Health when additional funding/services will be provided for the treatment of eating disorders (details supplied) in County Kerry. [7580/24]
View answerAs this is a service matter, I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.
536. Deputy Michael Ring asked the Minister for Health what developer the HSE entered into their operational lease agreement with for Ballyhaunis primary care centre; on what date that agreement was signed; and if he will make a statement on the matter. [7588/24]
View answerAs the Health Service Executive (HSE) holds responsibility for the provision, along with the maintenance and operation of Primary Care Centres, I have asked the HSE to respond to the Deputy directly, as soon as possible.
537. Deputy Michael Ring asked the Minister for Health the original date provided to the HSE for the completion of the Ballyhaunis primary care centre;; and if he will make a statement on the matter. [7589/24]
View answerAs the Health Service Executive (HSE) holds responsibility for the provision, along with the maintenance and operation of Primary Care Centres, I have asked the HSE to respond to the Deputy directly, as soon as possible.
538. Deputy Mattie McGrath asked the Minister for Health if the Government, given the implications of the adoption and ratification of the proposed WHO Pandemic Treaty and proposed amendments to the International Health Regulations, will enable a recourse to the people (details supplied) and thereby enable a constitutional referendum to be held to ascertain the views of the people, who are guardians of the Constitution; and if he will make a statement on the matter. [7599/24]
View answerI thank the Deputy for his query in relation to the World Health Organisation Pandemic Treaty (WHO CA+) and the ongoing process of amending the International Health Regulations (2005) (IHR).
The COVID-19 pandemic demonstrated that the global status quo in terms of pandemic preparedness and response is not adequate and requires revision. As pandemic type diseases are not contained by country borders, Ireland strongly supports a multilateral approach to global health issues with the World Health Organisation (WHO) in a central leadership role.
On 1 December 2021, the members of the World Health Organisation (WHO) reached consensus to begin the process to negotiate a convention, agreement, or other international instrument to strengthen pandemic prevention, preparedness, and response, commonly known as the Pandemic Treaty.
Ireland supports this WHO-led process to negotiate a binding legal instrument on pandemic preparedness and response. The aim of such a Pandemic Treaty is to protect public health and to help save lives in the event of future pandemics.
An Intergovernmental Negotiating Body (INB) was established and met for the first time on 24th February 2022. The INB has met seven times to date, with its eight-meeting scheduled to take place from 19th February to 1st March, to progress work on drafting this agreement. A progress report was delivered to the 76th World Health Assembly in May 2023, and negotiations are continuing towards presenting a final agreed text for adoption at the 77th World Health Assembly in May 2024.
The purpose and scope of the International Health Regulations (2005) (IHR) is to prevent, protect against, control, and provide a public health response to the international spread of disease in ways that are commensurate with and restricted to public health risks, and which avoid unnecessary interference with international traffic and trade. These Regulations provide inter alia, the basis within international law, for the setting up of reporting structures for the monitoring and reporting of issues relating to infectious diseases, particularly where they may pose an international threat.
In relation to the Deputy’s query on holding a constitutional referendum to ascertain the views of the people on the WHO Pandemic Treaty and the amendments to the IHR (2005); I wish to inform the Deputy that the proposed instruments are currently still in negotiation, and it is not possible at this time, to determine the precise legal ramifications of the instruments, nor has it been determined what form the instruments shall take. These negotiations are due to conclude in May 2024. Once concluded, the final text of the amendments to the IHRs and the WHO Pandemic Treaty will be presented to Cabinet for approval before adoption.
As provided for in the Irish Constitution, the conclusion of an international agreement is an exercise of the executive power of the State in connection with its external relations and is therefore concluded by or on the authority of the Government. Article 6(2) of the Irish Constitution that the Deputy has referenced, confirms that the ‘… powers of government are exercisable only by or on the authority of the organs of State established by this Constitution.’ In practice, this means that Government approval must be sought for the signature, ratification, or approval of any international agreement.
The requirements of the Irish Constitution will, of course, be fully respected in Ireland’s position towards the negotiations and my department will engage with the Office of the Attorney General in relation to any concerns that may arise in that regard.
539. Deputy Seán Canney asked the Minister for Health if a medication will be approved for a person (details supplied); and if he will make a statement on the matter. [7623/24]
View answerThe Health Service Executive (HSE) has statutory responsibility for decisions on pricing and reimbursement of medical products under the community drug schemes, in accordance with the Health (Pricing and Supply of Medical Goods) Act 2013.
The HSE advise that the following pain relief patches are currently available on the reimbursement list:
• Durogesic DTrans Transdermal patches
• Fental Matrix Transdermal patches
• Matrifen Transdermal patches
• Fentadur Transdermal patches
• Butrans Transdermal patches
• Versatis plasters (subject to a managed access system, indicated for post-herpetic neuralgia)
Patients prescribed Versatis plasters are reviewed by the Medicines Management Programme (MMP) for reimbursement approval, on foot of an application by the patient’s clinician, through the HSE online system.
In exceptional circumstances, Versatis plasters may be approved for supply for unlicensed uses. If an application is refused, the clinician may make an appeal to the MMP by email, making a clear clinical case for the patient. This process ensures that post-shingles patients, and other patients as clinically appropriate, can continue to have this specific treatment.
As this question also raises a service matter in respect of a specific individual, it has also been referred to the HSE who will respond directly to Deputy, as soon as possible.
540. Deputy Jim O'Callaghan asked the Minister for Health when the position of occupational therapist for the Dublin 4 region (CH06) will be filled; and if he will make a statement on the matter. [7625/24]
View answerAs this is an operational matter for the Health Service Executive, the HSE has been asked to respond directly to the Deputy.
541. Deputy Rose Conway-Walsh asked the Minister for Health to list and detail any acute beds that have been removed from Mayo since 2020; the net acute bed position from the start of 2020; and if he will make a statement on the matter. [7628/24]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the deputy directly, as soon as possible.
542. Deputy Colm Burke asked the Minister for Health if he will provide a status update in relation to the commencement date and roll-out of the National Advisory Group for Provision of Post-Mastectomy Products, Community Funded Schemes Service Improvement Programme in CHO1; and if he will make a statement on the matter. [7635/24]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
