Written Answers Nos. 30-43
30. Deputy Peadar Tóibín asked the Minister for Health the consideration he has given to the proposal to benchmark the ex-factory price of medicines at the lowest rather than the average of comparable European states; if he accepts that this is the practice in a number of other EU member states; if he accepts the projected savings figure cited of €280m; and if he will make a statement on the matter. [57028/12]
View answer34. Deputy Barry Cowen asked the Minister for Health the reason drug prices remain high here relative to other countries; and if he will make a statement on the matter. [57062/12]
View answerI propose to take Questions Nos. 30 and 34 together.
The prices of drugs vary between countries for a number of reasons, including different prices set by manufacturers, different wholesale and pharmacy mark-ups, different dispensing fees and different rates of VAT. In recent years, a number of changes to the pricing and reimbursement system have been successfully introduced in Ireland. These have resulted in reductions in the prices of thousands of medicines. Following intensive negotiations involving the Irish Pharmaceutical Healthcare Association (IPHA), the HSE and the Department of Health, a major new deal on the cost of drugs in the State was concluded in October last. It will deliver a number of important benefits, including: significant reductions for patients in the cost of drugs; a lowering of the drugs bill to the State; timely access for patients to new cutting-edge drugs for certain conditions; and reducing the cost base of the health system into the future.
The gross savings arising from this deal will be in excess of €400m over 3 years. €210 million from the gross savings will make available new drugs to patients over 3 years. Thus, the deal will result in a net reduction in the HSE expenditure on drugs of about €190m. The Department of Health and the HSE have also successfully finalised discussions with the Association of Pharmaceutical Manufacturers in Ireland (APMI), which represent the generic industry, on a new agreement to deliver further savings in the cost of generic drugs. It is estimated that the combined gross savings from the IPHA and APMI deals will be in excess of €120 million in 2013. The IPHA agreement provides that prices are referenced to the currency adjusted average price to wholesaler in the nominated EU member states in which the medicine is then available. The prices of a range of medicines are due to be reduced on 1 January next in accordance with the agreement. The Health (Pricing and Supply of Medical Goods) Bill 2012, which is currently before the House, provides for the introduction of a system of generic substitution and reference pricing. The Bill provides that when the HSE is setting a reference price for, or reviewing a reference price set for, a relevant group of interchangeable medicinal products it shall take into account the following criteria: the ability of suppliers to meet patient demand for the relevant item; the value for money afforded by the relevant item; the equivalent prices of the relevant item in all other Member States where the product is marketed; the prices of therapeutically similar items; and the resources available to the HSE.
It is important to balance achieving best value for money for the taxpayer with assuring continuity of supply for critical medical products, particularly in a small market like Ireland. Consequently, the Bill aims to achieve value for money while avoiding disruption in the availability of medicines on the Irish market.
31. Deputy John Halligan asked the Minister for Health further to Parliamentary Question No. 530 of 11 December 2012, if he is satisfied that he has no obligation to ensure detailed consultation and full engagement between the Health Service Executive, the Irish Hospital Consultants Association and the Irish Medical Organisation on issues that impact on their members; if he does have an obligation in this regard if has he fulfilled this obligation with regards to proposed new access protocols for 16 and 17 year olds to mental health services; and if he will make a statement on the matter. [57097/12]
View answer48. Deputy Richard Boyd Barrett asked the Minister for Health further to Parliamentary Question No. 530 of 11 December 2012, if he is satisfied that he has no obligation to ensure detailed consultation and full engagement between the Health Service Executive, the Irish Hospital Consultants Association and the Irish Medical Organisation in issues that impact on their members; if he does have an obligation in this regard if has he fulfilled this obligation with regards to proposed new access protocols for 16 and 17 year olds to mental health services; and if he will make a statement on the matter. [57031/12]
View answerI propose to take Questions Nos. 31 and 48 together.
The issues raised by the Deputies are matters in relation to which the HSE has specific statutory obligations. The HSE is obliged under the Employees (Provision of Information and Consultation) Act, 2006, to engage with the trade unions in relevant circumstances. In addition, under the terms of the Public Service Agreement, the HSE has a responsibility to ensure that engagement with trade unions takes place, to take account of staff concerns and rights, in relation to organisational and service changes. I have asked the Executive to reply directly to the Deputies concerning consultation and engagement with the Irish Hospital Consultants Association and the Irish Medical Organisation in relation to the expansion of mental health services for 16 and 17 year olds.
32. Deputy Charlie McConalogue asked the Minister for Health the latest figures for the employment of agency staff in acute hospitals in 2012; the other alternatives to agency staff that are being used; and if he will make a statement on the matter. [57071/12]
View answerThe Government has decided that the numbers employed across the public service must be reduced in order to meet its fiscal and budgetary targets. The health sector must make its contribution to that reduction.
Agency staff may be used only in the most exceptional of circumstances and when all alternative avenues have been exhausted. Such staff may only be engaged when signed off by identified senior management.
The Health Service Executive will shortly be introducing an Employment Initiative/Placement Scheme for Graduate Nurses and Midwives. Under the scheme graduate nurses and midwives will be offered the opportunity to apply to take part in a two year placement programme in the public health services. In particular, the scheme has the potential to enable nurses with limited or no work experience post-graduation to gain such experience and to benefit from mentoring and skills development. The scheme is also intended to contribute to a reduction in expenditure on agency staffing and overtime in the health service. The HSE is proceeding with arrangements to finalise the details of the scheme, including the eligibility criteria, and will be inviting applications early in 2013.
With regard to the latest figures for the employment of agency staff in acute hospitals in 2012, this is a matter for the Health Service Executive, and as such, the Deputy's enquiry has been referred to the HSE for direct reply.
33. Deputy Michael McGrath asked the Minister for Health the position regarding the reconfiguration of hospital services in the south east; his plans regarding same; and if he will make a statement on the matter. [57074/12]
View answer61. Deputy Sandra McLellan asked the Minister for Health the date on which he or his Department will receive the report on hospital groups (details supplied); the date on which he will publish the report and his plans to progress the implementation of hospital groups; if he will commit to maintaining the cohesion of the south east region as a single hospital group; and if he will make a statement on the matter. [57022/12]
View answerI propose to take Questions Nos. 33 and 61 together.
A key stepping stone towards the introduction of Universal Health Insurance will be to develop independent not-for-profit hospital trusts in which all hospitals will function as part of integrated groups. The rationale behind the establishment of hospital groups and trusts is to support increased operational autonomy and accountability for hospital services in a way that will drive service reforms and provide the maximum possible benefit to patients. Reform across the three domains of access, quality and resources is not achievable unless there is real clinical and managerial accountability at hospital level.
The work on hospital groups is not about downgrading hospitals. It is about the bringing together groups of hospitals to form single cohesive entities to allow maximum flexibility in management, budgets and service delivery. Hospital groups will be established on an administrative basis pending the legislation required to set up hospital trusts by 2015. Before those trusts are established the make-up and functioning of the Groups will be reviewed and if changes prove necessary then they will be made with Government approval when the hospital trusts are being formed.
With specific regard to the South East, I have stated on numerous occasions recently that Waterford Regional Hospital will remain as one of the 8 existing national cancer care programme centres, with the same population referral base for cancer patients and with all of the associated services required to support this, such as joint consultant appointments (e.g. general surgery shared with Wexford). I have also reiterated that other services currently provided in Waterford, such as invasive cardiology and trauma services will continue to be provided there. The provision of services at any hospital site will, of course, primarily be determined by the appropriate clinical programme for that service, taking account of the population which the hospital serves and services provided by other hospitals which are within a reasonable commute.
Last June I appointed Professor John Higgins to chair a Strategic Board on the Establishment of Hospital Groups. The Strategic Board is composed of representatives with both national and international expertise in health service delivery, governance and linkages with academic institutions. A Project Team was established to make recommendations to the Strategic Board on the composition of hospital groups, governance arrangements, management frameworks and linkages to academic institutions.
The Project Team is currently finalising a Report on the recommendations outlined above, taking account of the observations and comments made by the Strategic Board and of issues which have been raised in submissions by a number of key stakeholders. The report is to be presented formally to me in early January. I will consider it and I will have any further consultation I require carried out as a matter of urgency. The report will then be presented to Government for decision on the composition of hospital groups in light of the recommendations of the Report.
35. Deputy John McGuinness asked the Minister for Health the number of bed closures in acute hospitals to date in 2012; and if he will make a statement on the matter. [57076/12]
View answerIn relation to the particular query raised by the Deputy, I have asked the Health Service to respond directly to the Deputy in this matter.
36. Deputy Jonathan O'Brien asked the Minister for Health if he will reconsider his rejection of the call by a person (details supplied) for a full public inquiry into the tragic death of their spouse at Galway Regional Hospital on 28 October 2012; and if he will make a statement on the matter. [57025/12]
View answerI am most anxious that all the facts are established in this sad case. The crucial thing now is that we must, in the interests of all the women of Ireland, uncover the facts of what happened as quickly as possible and take all necessary action.
At a Press Conference on 19th November the Health Service Executive (HSE) gave details of the Investigation Team which is being chaired by an international expert in obstetrics and gynaecology, Professor Sir Sabaratnam Arulkumaran. The Investigation will be completed within an expeditious timeframe.
On 23rd November the Board of the Health Information and Quality Authority (HIQA), following a request from the HSE and in accordance with Section 9(1) of the Health Act 2007, announced that it will investigate the safety, quality and standards of services provided by the HSE at University College Hospital Galway (UCHG) to critically ill patients, including critically ill pregnant women as reflected in the care and treatment provided to Savita Halappanavar. The Authority will prepare a report of the findings of the investigation which will then be submitted to the Board of the Authority for approval before publishing it at a time the Authority deems appropriate.
In conducting investigations such as these, it is preferable to have the input of the next of kin. Both Investigation Teams would welcome the input of Mr. Halappanavar to their inquiries and they remain open to meeting with him without prejudice. A Coroner's inquest will also be carried out as is standard practice in such cases.
In addition, in the case of a maternal death, a number of standard procedures are followed including a risk review of the case and the completion of a maternal death notification form, through Maternal Death Enquiry Ireland. The outcome of the investigations must be awaited before commenting further on this sad case.
37. Deputy Willie O'Dea asked the Minister for Health when legislation to provide for free general practitioner care will be introduced; and if he will make a statement on the matter. [57082/12]
View answer76. Deputy Sandra McLellan asked the Minister for Health if he will report progress on the roll-out of free general practitioner care; and if he will make a statement on the matter. [57023/12]
View answerI propose to take Questions Nos. 37 and 76 together.
The Programme for Government commits to reforming the current public health system by introducing Universal Health Insurance with equal access to care for all. As part of this, the Government is committed to introducing, on a phased basis, GP care without fees within its first term of office. Primary legislation is required to give effect to Government commitment to introduce a universal GP service without fees.
Legislation to allow the Minister for Health to make regulations to extend access to GP services without fees to persons with prescribed illnesses is currently being drafted by the Office of the Attorney General and the Department and it will be published shortly. Implementation dates and application details will be announced in due course.
An additional amount of €15 million was provided in Budget 2013 for the roll out of GP care without fees.
38. Deputy Pádraig Mac Lochlainn asked the Minister for Health the steps that will be taken to address the excessive waiting list for paediatric services in Letterkenny Hospital County Donegal; and if he will make a statement on the matter. [57018/12]
View answerUnblocking access to acute hospitals is a key aim of this Government, and of the Special Delivery Unit established by the Minister for Health. The SDU was set up immediately following the Minister’s appointment and the initial focus for the SDU's Scheduled Care Team has been on waiting times for in-patient and daycase elective surgery. For children, the target is that by the end of 2012 no child should be waiting for inpatient or daycase treatment for more than 20 weeks. Huge progress has been made towards this target – on 13 December, there were just 234 children waiting longer than 20 weeks compared with 1,759 at the end of December 2011. Improving access to outpatient services is the next priority for the Government. Building on work already undertaken by the HSE, the NTPF has now taken over the reporting of outpatient waiting time data. The collation and analysis of outpatient waiting time data in a standardised format will reveal the distribution of long waiters across all hospitals. In the first instance, this will allow the SDU and NTPF to target their resources towards those patients who are waiting longest and ensure that they are seen and assessed. A maximum waiting time target has now been set of 12 months for a first time outpatient appointment by 30 November 2013. In parallel with reducing the numbers of longest waiters, the SDU will also work with the HSE Clinical Programmes to reform the structure, organisation and delivery of outpatient services to ensure that the right patient is seen and assessed by the right health professional at the right time. In relation to the specific query raised by the Deputy, as this is a service matter it has been referred to the HSE for direct reply.
39. Deputy Martin Ferris asked the Minister for Health the number of persons with medical card entitlements and the projected increase for 2013; and if he will make a statement on the matter. [57020/12]
View answerThe number of persons eligible for a medical card at end-September 2012 is 1,836,689.
The information for 2013 will form part of the Health Service Executive 2013 National Service Plan, which is required to be published on foot of the Executive's allocation under the Estimates 2013 process.
40. Deputy Martin Ferris asked the Minister for Health the way the additional €35 million allocated for mental health services in 2012 was spent; if any of this amount has been carried over into 2013 and the way in which this €35 million allocated for 2013 will be spent; and if he will make a statement on the matter. [57021/12]
View answerFunding from the €35 million special provision for mental health in 2012 was allocated for measures primarily to further strengthen Community Mental Health Teams in both adult and children’s mental health services, to advance activities in the area of suicide prevention, to initiate the provision of psychological and counselling services in primary care, specifically for people with mental health problems and to facilitate the re-location of mental health service users from institutional care to more independent living arrangements in their communities, in line with A Vision for Change.
414 posts were approved to implement the €35 million package of special measures for mental health. To date 17 posts have been filled and over 270 offers of employment have already been accepted and the appointments are proceeding. Most start dates are expected to commence this month and costs will start to be incurred from that point. The full year costs of all of the above measures will be incurred from 2013 onwards.
The provisional outturn for mental health services has, like many other areas, been running ahead of budget and the end of year excess in this area will be met from the unexpended portion of the €35 million. It is not possible to say yet exactly how much of the €35 million will be spent on mental health services by the end of this financial year. The announcement in Budget 2013 of a further €35 million for the continued development of our mental health services is additional to the €35 million provided in Budget 2012. I will be engaging fully with the Health Service Executive to ensure that the developments to be put in place for this additional funding are reflected in the National Service Plan for 2013. Developments are expected to include the further strengthening of Community Mental Health Teams for adults, children & adolescents, older people, Mental Health Intellectual Disabilities Teams and a suicide prevention initiatives programme.
41. Deputy Catherine Murphy asked the Minister for Health the interest rate that will be applied to the overdraft extended to Tallaght Hospital Dublin to cover its budget overrun; the fund that will cover the cost of the interest payments; if it is envisaged that these repayments will impact on the patient services fund of the hospital; and if he will make a statement on the matter. [56890/12]
View answerTallaght, like every other hospital is facing significant financial challenges. The HSE has had regular ongoing engagement with the hospital with a view to ensuring that the hospital continues to deliver its 2012 service plan commitments in addition to maximising the considerable financial resources at its disposal.
Tallaght hospital has achieved significant operational savings in 2012 and has reduced its year-on-year spending by 6%, despite a 5% increase in in-patient numbers, a 6% increase in Emergency Department admissions and a 9% reduction in its 2012 allocation. Tallaght has achieved HSE targets for reductions in agency and overtime costs and its absenteeism is consistently lower than the HSE national target. It has also considerably reduced the average length of stay times and ED, inpatient and day case waiting times as well as practically eliminating hospital trolleys. The hospital’s staff has displayed great commitment to improving its performance and I am confident that this commitment will greatly assist in addressing Tallaght's current financial difficulties.
The use of overdraft facilities in the latter half of the year is part of the normal financing arrangements with voluntary hospitals. This has always been the case.
The specific query raised by the Deputy regarding the overdraft extended to Tallaght Hospital, has been referred to the HSE for direct reply.
42. Deputy Caoimhghín Ó Caoláin asked the Minister for Health the proposed changes to eligibility for the medical card that he plans to make in 2013; and if he will make a statement on the matter. [57003/12]
View answerNew eligibility rules for medical cards for persons aged over 70 years were announced in the Budget 2013. The income thresholds would be reduced and the higher income over-70s will receive a GP visit card instead of a medical card. The new rules will not take effect until later in 2013, after primary legislation has been enacted. The implementation date will be announced and publicised in advance by the Department and HSE.
When the changes come into effect, the following rules for medical cards for persons aged over 70 will apply:
-a single person over 70 with a gross income of up to €600 per week will qualify for a medical card and a single person over 70 with a gross income of between €600 and €700 per week will qualify for a GP visit card;
-a couple over 70 with a gross income of up to €1,200 per week will qualify for a medical card and a couple with a gross income of between €1,200 and €1,400 per week will qualify for a GP visit card.
In relation to eligibility for the standard medical card, the rules relating to a person’s spending and earnings that are taken into account when carrying out the means test will be tightened. My Department will first examine this proposal in more detail in consultation with the HSE. Again, the new rules and the implementation date will be announced and publicised in advance by the Department and HSE.
43. Deputy Brian Stanley asked the Minister for Health his plans to progress the Health (Pricing and Supply of Medical Goods) Bill 2012; and if he will make a statement on the matter. [57027/12]
View answerThe Health (Pricing and Supply of Medical Goods) Bill 2012 was published on the 13th of July 2012. The Bill completed its passage through the Seanad on Wednesday, the 19th of September, and resumed Second Stage in the Dáil on the 17th of December. The timetable for the Bill's progress through the Dáil is a matter for the Oireachtas.
