I propose to take Questions Nos. 641, 658, 694, 705 and 712 together.
The National Clinical Care Programme for Epilepsy is one of a number of National Clinical Care Programmes established by the HSE and now in various stages of development. These Programmes have three main objectives – to improve the quality of care, to improve access and to improve cost-effectiveness. Their primary aim is to modernise the way hospital services are provided across a wide range of clinical areas. This is being done through standardising access to and delivery of high quality, safe and efficient hospital services and maximising linkages to primary care and other community services. Cork and Beaumont are two of six regional centres which have been identified for the provision of specialist epilepsy services under the Clinical Care Programme for Epilepsy. It is intended that services will be provided by a team of nurses and consultant neurologists working as a virtual national network supporting all acute and primary care locations. Rapid Access Clinics (separate to the Epilepsy Monitoring Units) have been developed at four of centres so far and 10.5 (WTE) Advanced Nurse Practitioners have been recruited to lead these clinics, so that a total of 12 Advanced Nurse Practitioners are now in place across the four centres. When the Epilepsy Monitoring Units in CUH and Beaumont are open, they will increase pre-surgical evaluation capacity. Monitoring is required for the most vulnerable patients with the worst effects of epilepsy and their development is therefore a priority for the Programme. Patients at these units will require 24/7 care. The staffing requirements to enable the units to be safely opened have been identified.
With regard to recruitment, the Government has decided that the numbers employed across the public service must be reduced to meet its fiscal and budgetary targets. The health sector must make its contribution to that reduction. However, the HSE can make staff appointments once it remains within its overall employment ceiling and has the financial resources to do so. I understand that the normal processes will apply to the HSE’s decisions regarding the recruitment of the required staff in CUH and Beaumont. With regard to Beaumont, the HSE has advised that Beaumont Hospital and the HSE are working jointly to fill the posts necessary to support service development. I am advised that the staffing required for the unit includes five staff nurses, one consultant neurophysiologist and three technicians. Of these, three staff nurse posts and one technician post remain to be recruited. I am informed that this is being prioritised. The recruitment of nursing personnel is a key element to facilitate phased opening of the unit as nursing staff come into post. With regard to Cork, the HSE has advised that the Service Plan for 2013 for CUH is being drawn up currently and will be finalised in the coming weeks, and that the provision of additional staff for the Epilepsy Monitoring Unit is being considered as part of that process.
With regard to the issue of exemption from generic substitution of anti-epileptic drugs, under the Health (Pricing and Supply of Medical Goods) Bill, the Irish Medicines Board has statutory responsibility for establishing and publishing a List of Interchangeable Medicinal Products. In making a decision to add a medicinal product to a group of interchangeable medicinal products or a group of medicinal products to the List of Interchangeable Medicinal Products, the board is obliged to have regard to the criteria set out in the Bill. These criteria fully reflect the recommendations set out in the Joint Department of Health/HSE report "Proposed Model of Reference Pricing and Generic Substitution" (the Moran Report, 2010) regarding criteria for interchangeability. To further enhance the patient safety aspect of generic substitution, section 13 of the Bill allows a prescriber to indicate on a prescription that a branded interchangeable medicinal product should, for clinical reasons, not be substituted. I am satisfied that these provisions address the concerns raised. I met the Irish Epilepsy Association in January and explained this position.
