Ceisteanna ar Sonraíodh Uain Dóibh - Priority Questions

Question No. 42 replied to with Written Answers.

HSE Expenditure

Stephen Donnelly


43. Deputy Stephen Donnelly asked the Minister for Health the amount by which the HSE budget is overspent as of the end of quarter 2 of 2019; the projection for the full year overspend; the additional spending commitments he has made to date during 2019; his plans to seek a supplementary budget or bring full year healthcare expenditure in on budget; and if he will make a statement on the matter. [28086/19]

My question is about the HSE budget for this year. My understanding is that we have quarter 1 figures showing an overspend. I would like to know how much the overspend is for the first three months of the year and also for the second three months, to the end of June. I imagine the Minister's officials and-or the HSE are projecting out what the full-year overspend is likely to be. What is the projection at this stage? Is the Minister in line with the new director general of the HSE saying that the budget will be brought in or does he foresee himself coming back to the House to seek a supplementary budget later this year?

The management of health services finances is always challenging, as we have seen since the HSE was set up. There is a range of supplementary figures going right back to the start of the HSE that I could put on the record of the House. The indications are that performance so far this year is better than last year and, as the Deputy has acknowledged, significant efforts are under way on the part of the HSE and the new CEO, Paul Reid, to manage available resources effectively. The HSE’s latest income and expenditure position at 30 April 2019 shows a revenue deficit of €116.2 million, which represents 2.3% of the available budget. The main drivers of the deficit are acute hospitals; the primary care reimbursement service, PCRS, in other words, the medical card and demand-led schemes; disability services; and the treatment abroad scheme. Current gross expenditure on the Health Vote, year to date, is 6.8% higher than the same period in 2018. This compares with an overall increase in the Health Estimate compared to the 2018 outturn of 5.8%. This House budgeted for the health service to spend roughly 5.8% more this year than last year and the health service bill is, I think, so far 6.8% more. It is within a percentage point of what this House has budgeted.

Encouragingly and importantly, significant savings are profiled later in the year in line with the targets set out in the national service plan.

I have heard this misrepresented on many occasions in recent weeks. When the service plan was being drawn up, the HSE was asked - and instructed - as is the norm in most health services, including the UK's NHS, to put a saving's plan in place. On the basis of current trends, however, there would still be a significant challenge. This is a matter of concern for the Government. My Department is working with the HSE to continue to obtain further clarity on the projected year-end position and to mitigate the deficit insofar as is possible. We are working closely with the Department of Public Expenditure and Reform. I do not yet have a projected year-end figure. I support Mr. Paul Reid, the new CEO of the executive, in his calls for people to live within their budgets and to come in on budget. I will share any further information with Deputy Donnelly when I have it.

I have emphasised to the HSE and its new board the need to address health spending urgently by means of the following measures: steps to ensure compliance with the staffing limits for 2019 - in other words, to hire more but only within budget; a reporting and monitoring structure around agreed savings targets in the national service plan, with responsible managers providing a monthly report; and a mid-year review of the HSE's performance on savings and staffing limits. In addition, the establishment on Friday last of a new HSE board governance structure with strong competencies across key areas will further contribute to strengthening the oversight and performance of the HSE pending its further reorganisation.

If I heard him correctly, the Minister gave a figure of €116 million for the period to the end of April. Does he have a figure for the period to the end of June? This would be the overspend to the end of quarter 1. If he does not have that figure, perhaps the Minister will indicate when he will have it. Has the Minister requested a projection to the end of the year? Given the enormous overruns during the past years and in light of the fact that we are overspending again - by more than €100 million for the first four months of the year - it would seem prudent to request a forecast for the potential overrun. There is no contingency in the budget, which seems to be a mistake in the context of allocating resources for healthcare.

At budget time, the Minister announced a 10% increase in the assessment threshold with regard to means-tested GP visit cards. This was in line with the Sláintecare proposal. At the time, neither he nor his officials were able to cost this. Will the Minister indicate if this cost is included? Is the increase happening? If it is, when will it come into place? Does the Minister have a sense of how much it will cost?

I shall recap. Does the Minister have the figure to the end of June? Does the Minister believe that it is sensible to not have a contingency in the budget? Is the 10% increase in the assessment threshold for GP visit cards going to happen? Does the Minister believe that he will be able to drive the costs back down to be in budget for the full year or is he anticipating coming back to the House with a Supplementary Estimate?

The 10% increase in the assessment threshold for GP visit cards was implemented at the start of April. The budget for this would have been held back as a reserve in my Department. I say that from memory. If my account is inaccurate, I will send a note to the Deputy.

My position is to allow the new CEO, Mr. Reid, who has only been in the office for a few weeks, and the new board, which has only been in office since Friday, to do their own due diligence regarding the actions the HSE can take. I have been very clear in my message to Mr. Reid and the board that we expect them to deliver everything in the service plan. It is not about cutbacks or doing less. It is about delivering all of the extra activity and all of the additional staff under the service plan; it is not about doing things that are not costed. There are already some things that we in this House have asked the HSE to do that are not costed, such as continuing Brexit planning, the CervicalCheck ex gratia scheme and the recent nursing agreement, which the Deputy supported. There are ongoing discussions with trade unions and I have seen the Deputy on the picket line in support of that.

I do not believe that a contingency has ever been held back in respect of the HSE but I will check this. I do not have a more up-to-date figure. The figure I have just given is the most up-to-date available. It is probably even more up to date than the figure previously presented by the HSE.

I accept the Minister's point that there is a new director general of the HSE and that he is sent a circular that everything needs to be brought back into budget. The question for the Minister and the Government is what direction they are going to take. We are halfway through the year. By the end of April there was an overspend of €116 million. Let us assume that this increased in May and June at the same rate. This would bring us broadly up to €140 million. On the current trend and if things continue as they are, we would be looking at an overspend of several hundred million euro. At a political level - and accepting that everybody will do everything they can to live within the budget - if the HSE comes back and states that the overspend will still be €150 million, €250 million or €350 million, will the Minister instruct it to do what is required to find the necessary savings in order to come in on budget or will he come back to the House with a Supplementary Estimate?

Every Government of every hue monitors healthcare spending on an almost monthly basis in the run up to any budget. My message to the HSE is to deliver the service plan in full and, in parallel, to put in place greater controls in respect of individual managers. We have discussed this matter in the House. One cannot have individual managers recruiting without paying heed to the budget. In addition, they need to reduce the waste and inefficiencies in the system in accordance with the savings plans they were instructed to put in place as part of the service plan.

It is understandable that the Deputy is trying to project from now until the end of the year. It is important to note, however, that when one looks at how the savings are profiled in the HSE Vote, many of them are profiled for later in the year with those targets set out in the national service plan. At a political level I ask the HSE to come in on budget as close as possible while delivering the essential services people need.

At a political level, every day Deputies call on me to spend more on the health service, with calls for more for SIPTU workers, more for consultants and more for home care just in the past six weeks. Like my predecessors, I will try to balance the challenge between bringing the HSE in on budget - or as close to budget as possible - meeting the needs of our people and meeting the many demands this House understandably places on me in terms of improving Ireland's health service.

Hospital Consultant Recruitment

Louise O'Reilly


44. Deputy Louise O'Reilly asked the Minister for Health the number of consultant doctors operating in the health service, by hospital and speciality; the number of consultant doctor vacancies, by hospitality and speciality; and his views on the shortage of consultant doctors across the health service. [27799/19]

With regard to the Minister's reply to Deputy Donnelly's question, I rarely ask the Minister to spend more. I ask that he reorient the spending away from expensive agency staff and outsourcing and towards directly employed staff instead. The Minister has agreed on a number of occasions that this represents the best value for money.

My question today is very simple and relates to consultant doctors and the shortages thereof that are being experienced across the State. Perhaps the Minister will make the distinction between those consultants who are eligible to be on the specialist register and those who are not. This is an emerging issue within the health service. It is important whenever we count those figures to do so on a realistic basis and only count consultants who are on the register.

I thank Deputy O'Reilly for her question. The number of consultants working in the public health service continues to grow year on year. It increased by 125 whole-time equivalents, WTEs, or just over 4%, in the year to the end of May. I will get the clarification for the Deputy on these 125 WTEs and how many are on the specialist register. I do not have that information with me.

In the five years to the end of May, the number has increased by 533 - more than 20% - and now stands at 3,121 consultants working in the Irish health service. The details by hospital and specialty requested are being provided to the Deputy in response to this question and I have the tables here for the Deputy.

On vacancies, the national doctors training and planning division of the HSE has provided figures up to 27 June. This identifies 362 posts, by hospital and specialty, that have been approved for filling. Of these, 151 have been identified as vacant by the hospital or agency concerned. The hospital or agency concerned have, however, not confirmed the status of the other 211 posts. Again, the detailed figures provided by the HSE in respect of this element of the question are also being provided to the Deputy.

The public health service operates in a global market for medical specialists, which is experiencing a worldwide shortage. Notwithstanding this fact, progress continues to be made in attracting and retaining consultants and in addressing improvements in the training, working environment and career pathways for non-consultant hospital doctors - our future supply of consultant candidates. A range of factors have been identified as contributing to the recruitment and retention challenge, of which pay is a part. I hope the Deputy will recognise that because I understand that in 2012 she wanted to cap consultants' pay and specifically referenced reducing their pay in a policy document. Research published last year by the Royal College of Surgeons in Ireland, RCSI, also identified excessive service demands and the quality and consistency of training as critical challenges; so it is about pay but not just pay.

The issue of new entrant pay is being addressed in general terms under the terms of the Public Service Stability Agreement 2018-2020 and has been examined by the Public Sector Pay Commission. The Deputy will be familiar with that. I have given a commitment to finding a process to now engage with consultants, such as we do with GPs and nurses, to find a way forward on pay issues.

If we are going back over old history, obviously I will refer to the billboard campaign of the Minister's party on ending the scandal of patients on trolleys. How is that working out? It is not going terribly well.

We are making progress.

I will take on board what the Minister said in regard to a policy from seven years ago and I will remind him that it is 2019. We have a recruitment and retention crisis among consultants, which the Care Can't Wait campaign by the Irish Hospital Consultants Association, IHCA, is highlighting. My figures tell me we have 480 consultant vacancies across the State, which is an increase in the number of vacancies. While I am not disputing the fact there have been some hires, they are not keeping pace with demand.

The Minister referred to this being a worldwide problem. It is not a problem they are having in Perth, which is where our consultants and doctors are going, although they are being trained here. I go back to my earlier point that it is not about spending more money but about reorienting what we spend. A lot of the money we spend is spent abroad to recruit consultants, and much is wasted on agency staff and locums to fill the gaps that should be filled by directly employed staff.

It is fair game, when the Deputy asks a question on wanting to recruit more consultants, to point out that the policies she puts forward would result in fewer consultants.

In 2012, Sinn Féin believed consultants were paid too much.

Did the Minister end the scandal of patients on trolleys?

It is not like Deputy O'Reilly to be unruly. I tried to look at a document Sinn Féin published in November 2016 under the tile, Framework for New Pay Agreement, but it does not seem to be available on its website today. I suppose the party wants to try to hide the fact it believed these people were paid too much and it wanted to tax them more and reduce their salaries. Let us see what that will do in regard to sending our doctors to Perth.

We have more to do in this regard. I believe pay is an element of this but I also believe work practice change is an element. I believe the Deputy agrees with me on the need to make sure we have more consultants working in the public health service rather than doing private practice. I will go to Government with the de Buitléir report on proposals in that regard in the autumn.

In direct answer to the Deputy’s question on how we reduce the shortage of consultant doctors across the health service, we do it through engaging on the issue of pay and through a pay agreement and contracts, as I outlined at the IMO conference a few weeks ago. However, I also believe we do it through more radical reform, work practice change and the roadmap I expect the de Buitléir report to outline in line with the Sláintecare strategy.

I do not consider myself to be unruly but nor will I sit here and be misrepresented. As to the engagement the Minister speaks of, how does that manifest itself in his daily work? What is the level of engagement? As the person in charge, what is the Minister's level of engagement with, for example, the IHCA or the IMO? Has he sat down with them directly? Does he have a plan in place?

In recent weeks, both Susan Mitchell and Paul Cullen have quoted from the report to the national doctors training and planning project team on the employment of consultants not registered in a specialist division of the register of medical practitioners. That is a very serious issue and it is not being dealt with. It is not good enough to hide behind what the Minister says is an international crisis. I will get the document the Minister refers to. I have addressed the IHCA conference and I have spoken to the consultants in this regard. I have no difficulty with people being paid well for a job well done but we have a recruitment and retention crisis. Pay is a serious element of that and it needs to be addressed. However, at the moment, the Minister presides over a health service that is a deeply unattractive place to work. That is why we cannot recruit and retain consultants. That is why we are spending money, day in and day out, going abroad to recruit consultants and plugging the gaps with agency staff. I have not heard anything from the Minister today that leads me to believe it will be any different.

As the Deputy says, I preside over a health service that has seen more than 90% of GPs - the front-line doctors in our communities - accept the new agreement and contract that I have put to them. It is probably unheard of to achieve such massive acceptance of a deal, in this case one which will invest €210 million more in general practice. I preside over a health service that has seen our nurses in overwhelming numbers vote in favour of a new nursing contract that will see their pay increase but will also see their work practices change. I preside over a health service that is seeing more consultants work in it this year than last year, and more than in the last five years, to the tune of several hundred.

We have more to do. I believe that, sequentially, much progress has been made with regard to GPs and nursing and midwifery. Consultants are the next issue. I have met the IHCA directly here in Leinster House in relatively recent weeks and my Department has had a number of follow-on engagements with it as well. I have met the IMO and I have addressed its conference in regard to the issue. I and Government colleagues now want to take the Public Service Pay Commission recommendation of putting a process in place to talk about how we address the recruitment issues but I am making the point that, as in any negotiation, both sides will have asks. There are views in regard to pay on the consultant side but there will also be views in regard to work practice changes and the delivery of Sláintecare on our side. I hope and expect to make progress on that in the autumn.

National Drugs Strategy

John Curran


45. Deputy John Curran asked the Minister for Health if he will consider implementing a national multi-annual education and awareness campaign on drugs in view of the recent report from the European Monitoring Centre for Drugs and Drug Addiction; and if he will make a statement on the matter. [28087/19]

The Minister of State will be aware that illicit drug use and prevalence is on the increase. It is obvious if one looks at the reports of illegal drug dealing on our streets and, more importantly, if one acknowledges the increased seizures the Garda is making, particularly, as the economy recovers, around the area of cocaine. In light of increased drug prevalence, my question is whether the Government will consider developing and implementing a national multi-annual education and awareness drugs campaign.

The European drug report presents an overview of the drug situation in Europe, covering drug supply, use and public health problems, as well as drug policy and responses. The drug problem across Europe is of great concern, with the growing problem of cocaine use a particular worry.

The national drugs strategy, Reducing Harm, Supporting Recovery, is our whole-of-Government, multi-annual response to drug and alcohol use. It commits to dealing with substance use as a public health issue. A specific objective of the strategy is to prevent the use of drugs and alcohol at a young age. Evidence suggests that comprehensive school-based programmes that combine social and personal development and provide information about substance use are more likely to be effective. This is a key component of the new Department of Education and Skills well-being policy statement and framework for practice, which is being implemented on an ongoing basis. In addition, the Department of Education and Skills and the HSE are in the final stages of developing an educational prevention programme for schools on drugs and alcohol for the junior cycle and the senior cycle called Know the Score. Again, this will be available on an ongoing basis.

Developing harm reduction interventions for at-risk groups is another objective of the national drugs strategy. The HSE has developed a number of early harm reduction responses for people attending festivals, students and people who use cocaine. These campaigns offer practical harm reduction information, as well as advice on how to reduce the risks of drug use.

My priority is to promote healthier lifestyles within society. Through the twin-track approach of Healthy Ireland and the national drugs strategy, I believe we can offer our young people positive alternatives to drugs and alcohol.

I thank the Minister of State for her reply. We need to go a step further than we have gone. We have changed attitudes and behaviours in this country around many issues. If we look at the work that has been done around drink-driving and our road safety campaigns, this has affected outcomes. Some 20 years ago, more people would have died on our roads than would have had a drug-related death. This year, there will be more than 700 drug-related deaths. It is a huge number. We need to approach the whole area much more radically. Our programme of awareness and education needs to be run on a national basis. While the Minister of State has spoken clearly about running programmes for those who are in education, it is important that people who have left education are part of that programme. It is important that people who may buy cocaine or any other illicit drug in a nightclub tonight realise not just the harm they are potentially causing themselves, but that they are fuelling gangland crime. A national education and awareness campaign is a necessity and it needs to be in addition to all the work that is being done in the national drugs strategy and the work being carried out by the drugs task forces.

The Deputy is well aware of the strategy and what it is doing in regard to education in secondary schools and primary schools. A huge amount of work is also being done on the ground in communities through the drugs task forces which would not be possible without their input, as the Deputy knows. There are also other campaigns. As I said, the HSE has launched a harm reduction campaign for music festivals which commenced recently at the Body and Soul festival and was very successful on the ground. Last year, the Ana Liffey drug project launched a new national cocaine harm reduction campaign. This was aimed at young people, as well as older people, with a view to raising awareness of the dangers of taking cocaine and how it can affect not only them but the individuals around them and wider society.

I understand the problems at local level with the use of cocaine. This requires proper input at community level.

We should be talking about how we can influence young people at community level. This can and is being done not only through our schools but through the community organisations. There has been a huge roll-back in the supply of funding into communities. As the Deputy will be aware the €1 million for the new drugs projects will be spent in communities. The drugs task forces and related organisations will have an input in that regard.

I do not agree with the Deputy on the need for a national campaign. There is a lot happening under the national drugs strategy, which was put together following public information meetings, to assist us on our journey of helping those who are young and old in reducing the harm that drugs cause.

I thank the Minister of State for her response, but I regret I do not agree with her. I think we do need a national campaign. In her initial response, the Minister of State spoke about a number of individual campaigns, including the music festival campaign and the schools campaigns. They are fine but we need a co-ordinated national programme. Not everybody who is involved in taking illicit drugs is in education or school. Many people are recreational or casual users and they are not caught with those campaigns.

To be fair to the drug task forces, the level of funding they are receiving now in comparison with what they received a decade or more ago is not sufficient to run extensive, robust, educational awareness campaigns. The drugs task force in my area originally catered for a population of approximately 30,000. It is now catering for a population of over 100,000 people. This is not practical or feasible at the current level of funding. I acknowledge that the task forces are getting an additional €20,000 this year but that is not sufficient. Given the number of drug-related deaths, the increase in prevalence, the evidence of on-street drug dealing and the seizures by An Garda Síochána, in addition to the work being done by the drugs task forces and the initiatives under the national drugs strategy, we need a national educational awareness campaign. We need this campaign, not in replacement of existing initiatives but in addition to them.

The Deputy and I will have to agree to disagree. I do not believe we need a national campaign. As I said, there is a lot happening in this area.

The Deputy raised a number of issues in regard, in particular, to the task forces. Since 2008, funding has been reduced. We all acknowledge that but it is important to focus on the present rather than the past. We are working to fill the gaps in the drugs task forces. The level of funding has improved on what it was five or six years ago. As I said, there are a lot of initiatives happening. I agree with Deputy Curran that we need to target the funding to the right areas but I do not agree with him on the need for a multiannual educational awareness campaign because I think that is already happening through the Department of Education and Skills and other agencies and the oversight forum, of which I am member and into which all Departments have an input. There are many projects of work happening within the CHO areas under the auspices of the Departments of Education and Skills and Health and from across the board. The Departments and community groups are taking a multifaceted approach to how we can highlight the concerns around drugs issues. There is an obligation not only on politicians but on communities to make young people aware of what drugs and alcohol can do to them not only now but into the future.

The lapsed early warning and emerging trends network, which advised the Government on exchange information and new psychoactive substances, has been re-established and it is starting to make progress. There is a lot going on. I will talk to the Deputy at length about his question in the near future.

Rights of People with Disabilities

Thomas P. Broughan


47. Deputy Thomas P. Broughan asked the Minister for Health his views on the right of persons with disabilities to a personal assistant; the steps he is taking to introduce same; and if he will make a statement on the matter. [27558/19]

The Minister will be aware that in 2018, 2,535 people were in receipt of a personal assistance service. In this regard, the total number of hours was 1.6 million, which is an average of 1.73 hours per day per person in receipt of personal assistance. The Minister will also be aware that we have received extensive briefings in the past number of months from Independent Living Movement Ireland, as I am sure the Minister has as well. It would like an additional 500,000 hours per annum, at least, and would like Article 19 of the UN Convention on the Rights of Persons with Disabilities introduced here by way of legislation. We have also had excellent briefings from the Irish Wheelchair Association, which is headquartered in my constituency, and from a young journalist, Ms Niamh Ní Ruari, in regard to her experience of personal assistance.

I thank Deputy Broughan for raising this important issue.

In line with Government policy, the HSE provides personal assistant, PA, services that are person-centred, equitable and transparent to people with a physical and-or sensory disability.

People with disabilities are now living longer and living with a range of complex needs. In line with national policy implemented under Transforming Lives, the focus in recent years has been to enable people with disabilities to live lives of their choosing. The provision of personal assistant hours is an essential component of this policy.

The HSE's National Service Plan 2019 commits to providing 1.63 million hours of personal assistance to 2,535 people with a disability, representing an increase of 170,000 hours over the 2018 target.

The HSE has consistently, year on year, increased the number of hours of PA service delivered, resulting in the overall number of personal assistance hours increasing by 26% between 2013 and 2018, an increase in real terms of 340,000 hours. Over the same period the number of people receiving PA services has increased by approximately 480 to 2,535.

The PA works on a one-to-one basis in the home and the community with a person with a physical or sensory disability. A vital element of this personalised support is the full involvement of the service user in planning and agreeing the type and the times when support is provided to them. Supporting independent living must enhance the person's control over his or her own life.

Article 19 of the UN Convention on the Rights of Persons with Disabilities states that disabled people should live where they wish and with whom they wish, should enjoy a range of community support services including personal assistance, should enjoy community life and its opportunities on an equal basis to non-disabled people and should not be subject to isolation or segregation. The PA service provided by the HSE adheres to these principles.

In the normal course of service delivery, an individual's requirements are constantly reviewed to ensure services meet changing need. An individual's personal assistant hours may be adjusted following a service review where demand can result in one individual's hours being reduced to address priority needs of other people with disabilities within that community.

Additional information not given on the floor of the House.

This much needed flexibility gives local community healthcare organisations the freedom to target personal assistant hours to maximum effect within their area.

Beyond the clear policy and operational arrangements which I have outlined and which facilitate the availability of appropriate and growing levels of personal assistant support, I have no plans for legislation governing the rights, entitlements and operations associated with this service.

I thank the Minister of State for his response but he did not say whether or not he believes in the right to personal assistance. As the Minister of State is aware, in 2017 almost 85% of people in receipt of personal assistance services received less than three hours service per day. We have heard that some people receive as little as 40 minutes assistance per day, such that there is hardly time to get breakfast, showered and dressed to go to work or to an appointment. Some people are in receipt of a very little amount of time. We know the realities of this. Dr. Cathal Morgan sent me an excellent reply on foot of my question to the Minister, Deputy Harris, on this matter, in which he set out the small increases over the years which the Minister of State outlined in his reply but he did not deny the fact that the funding for personal assistance has not increased since 2008. For 11 years, including the three during which the Minister of State, Deputy Finian McGrath, has been in office, there has been no increase in funding in this area. The reality is that a right to personal assistance is not being delivered. Joan Carthy of the Irish Wheelchair Association, who the Minister of State and I know, made the point that even with the additional 170,000 hours provided last year there are still a wide range of citizens who are not getting the personal assistance rights.

On the rights issue, as the Deputy knows, I am the person who ratified the UN Convention on the Rights of Persons with Disabilities-----

The protocol has not been ratified.

-----which many people on the Opposition benches talked about doing for over 20 years.

The protocol has not been ratified.

The Minister of State, without interruption. Deputy Broughan will have another minute later.

I support Article 19 of the UN Convention on the Rights of Persons with Disabilities which states that disabled people should live where they wish and with whom they wish. That is my position. This Government ratified the convention. A lot of people in this House, including Deputy Broughan, sat on the pot for many years and did nothing about it.

Deputy Broughan spoke about hours. As I stated, the number of hours of personal assistance has increased by 200,000. In 2013, there were 1.291 million personal assistance hours. In 2018, the figure was 1.63 million hours. I want to do more and there are people who could do with more hours but I also want to bury a myth. People who receive personal assistance regularly come to my office and I have yet to meet one who receives three hours of personal assistance per week. Most of those I meet get between 20 and 30 hours per week. If there are people who are excluded, I am determined to include them.

I call Deputy Broughan to ask his final question.

There are 200,000 hours to do that. We have restored the respite care grant which is a significant help.

The Minister of State will have another minute if he wishes to elaborate.

I will introduce a personalised budget shortly which will give more independence to people with disabilities.

The Minister of State does not seem to accept the figures provided by the Independent Living Movement Ireland. The reality is that the Minister of State did not legislate for the optional protocol. If he was serious about the convention, he would have legislated for that and article 19, which gives the right to a personal assistant. He did not do that because his Fine Gael masters would not let him-----

Do not drag me into it.

-----because they are not prepared to provide the finance. Three years have been wasted and the Minister of State has not delivered. I will go on the figures that I have in front of me-----

It is the Battle of Clontarf.

-----from the Independent Living Movement Ireland and the Irish Wheelchair Association. Will the Minister of State commit to legislating under article 19 to give a right to personal assistance? Will he also accede to the request of the Irish Wheelchair Association to have the Central Statistics Office find out how many hours are needed and to what extent the Government is providing for the right of persons with a disability to have a personal assistant?

The partnership Government ratified the UN convention and we are very proud of that. The optional protocol will be done when we have certain matters finalised.

It will be done by us.

We are way ahead of other European countries with regard to the UN convention.

We are not ahead of Sweden.

In this year's HSE service plan, €1.904 billion is provided for disability services. That is an increase of 7.5%, yet Deputy Broughan is telling Deputies and people on the north side of Dublin that I am cutting the service. It is a load of rubbish.

I know what the Minister of State is doing.

Not only is the Deputy misleading the people but he ran away from going into government.

I know what the Minister of State has done.

You did not have the bottle to go into government. You are sitting on the pot over there when you had a chance to help me to get more services for people with disabilities.

You supported the Fianna Fáil and Fine Gael agenda.

Members must address their remarks through the Chair.

Deputy Broughan does not know how to deliver. There is no point in him coming into the Dáil if he cannot stand up and represent the people.

The Minister of State is a lap-dog.

I am proud to represent the people of Dublin Bay North, especially people with disabilities.

What about the Irish Wheelchair Association?

It is essential that we support people with disabilities. I fully support article 19 and I will act on it, rather than talk about it, as Deputy Broughan does with all his hot air.

I thought people sat on the fence, not on a pot.

Cannabis for Medicinal Use

Gino Kenny


46. Deputy Gino Kenny asked the Minister for Health if other conditions such as chronic pain will be considered for inclusion in the pilot of the commencement of the medical cannabis access programme; and if he will make a statement on the matter. [28227/19]

Will other conditions be included in the medical cannabis access programme?

To break out a bit of harmony after the previous question, I thank Deputy Gino Kenny for his role in advocating for medicinal cannabis. We may not fully agree on the approach to take but I acknowledge the Deputy's sincere commitment on the issue of medicinal cannabis and helping people from a compassionate point of view. I also acknowledge Deputy Micheál Martin's work on this issue. Deputies Gino Kenny, Micheál Martin and I worked for a lengthy period on this issue, which is beyond politics. Other Deputies also worked on it. I was pleased to be able to sign into law legislation underpinning the medical cannabis access programme on 26 June. It is fair to say, as Deputy Kenny acknowledged, that this is a significant milestone and represents the outcome of more than two years of detailed work involving the Health Products Regulatory Authority, HPRA, an expert reference group of clinicians, since it was important to get clinical buy-in, the Health Service Executive and my Department.

With this legislation in place, for the first time in Ireland potential producers and suppliers can apply to the HPRA to have cannabis products assessed for suitability for medical use in this programme. The programme is intended for patients with certain conditions for whom conventional medicines have not worked. This is not the first line of treatment but for people who have tried everything else for these conditions where conventional medicine is not working and their treating consultant believes this to be an appropriate course of action. Once suitable products are available, it will be possible for a medical consultant to prescribe a listed cannabis-based treatment for a patient under his or her care for the following medical conditions where the patient has failed to respond to standard treatments, namely, spasticity associated with multiple sclerosis, intractable nausea and vomiting associated with chemotherapy, and epilepsy. Work on establishing this programme began in March 2017 and follows on from the roadmap laid out by the Health Products Regulatory Authority’s expert report titled, Cannabis for Medical Use - A Scientific Review, published in March 2017.

The HPRA report did not recommend the inclusion of chronic pain in the access programme, but I reassure the Deputy, who has taken a close interest in the development of the programme, that this position will be kept under review and if better clinical evidence becomes available in the future, the inclusion of conditions such as chronic pain can be considered. For patients with conditions such as chronic pain, the ministerial licence route is an option to access medicinal cannabis outside of the programme.

This has been a long journey and the end of that journey last Wednesday, when we finally saw the law being changed and people being given access, was one of the proudest days in my time in the Dáil. I am contacted daily by people who want to see progress on this issue. To be fair to the Minister, he wants to see progress. We probably differ on certain issues but we got there in the end. It has been a brutal, protracted process. An issue that has been raised over the last three years is the omission of chronic pain from the guidelines, especially from the HPRA's scientific report. The efficacy of cannabis for chronic pain has been well researched. It is viable as a substitute for opiate-based medicines. In the five-year pilot project, will other conditions, especially relating to chronic pain, be added to the programme?

My approach to this, which the Deputy and I have discussed on many occasions, is that I have to be led by the views of clinicians. I take that approach because they are the people who have the medical expertise and we need them to buy into the programme. In some countries politicians have pretended to introduce programmes that had no clinical support whatsoever. The success of this programme so far, tortuous as it has been, is that there is significant clinical buy-in. Clinicians themselves have quite rightly drawn up the guidelines for it. Other conditions will be kept under review. We have the clinical expert group in place and it can be reconvened from time to time. I want to say to people who are not covered by the three conditions in the medical cannabis access programme that the ministerial licence scheme, under which a consultant may apply to the Minister of the day for access to a product that is not authorised, is still available. I have never refused an application and I do not think any of my predecessors or successors would do so either. If a consultant seeks access to a product, my Department generally recommends acceptance and the application is handled quickly. The consultant or treating doctor has to believe a person needs the treatment. We are happy to keep these matters under review. We have made significant progress in establishing this first programme.

The current licensing system, under which 21 licences have been granted, is cumbersome and is not workable. The majority of the licence-holders cannot be reimbursed. Last week, I raised the cases of two families who have to spend more than €10,000 a year. They have to travel to Holland four times a year to get a prescription. I do not think there is any other drug or substance for which people must leave the State if they wish to bring it in under licence. That is somewhat bizarre.

When Britain changed the law on 1 November, medical cannabis could be prescribed for chronic pain as part of the programme. Under the Danish system, which we are seeking to emulate, neuropathic pain is part of the programme. I know that chronic pain is a broad term.

When one considers that one person in six suffers from chronic pain and 40% of those who suffer do not have any relief whatsoever from opiate-based medicines, because of the crisis in the over-use of opiates, not only in Ireland but across the world, medicinal cannabis should definitely be a viable option for the very many who suffer excruciating chronic pain.

Different countries do slightly different things. If my memory serves me correctly, the Danish programme referenced by Deputy Gino Kenny does not include children and our programme does. Different countries are trying different things because we are at a very early stage in terms of continuing to assess the medical evidence. I approach the issue from a very simple point of view; if one is sick and in pain and nothing else will work and a doctor believes medicinal cannabis will help, I want - as we all do - to be able to respond compassionately, but I must move with the clinical community, with the evidence and with the regulator as well. We have made good progress.

I wish to pursue the points the Deputy made about reimbursement and travel because I think we can make progress on both of those. With the changes I made to the law last Wednesday, it may be possible to now start stocking some of those products in pharmacies for patients who are authorised, which might reduce the need to travel. We have made some progress on the reimbursement, but I think we can do more. For people who are on the cannabis access programme, the cost of the cannabis product will be met by the HSE. If one has a medical card, one will just pay the prescription charge and if one is on the drug payment scheme it will be the same as any other trip to the pharmacy as well. I am happy to continue to interact with Deputy Gino Kenny for patients who need cannabis for a medical reason to lessen their pain after everything else has been tried. We can keep these things under review.