Tuesday, 14 May 2013

Written Answers Nos. 680-702

Hospital Charges

Questions (681)

Alan Farrell

Question:

681. Deputy Alan Farrell asked the Minister for Health the position regarding allowing minor injury units to introduce fees of €100 for patients; and if he will make a statement on the matter. [22812/13]

Written answers

Minister for Health

With effect from 1 March 2013, under the Health (Out-Patient Charges) Regulations 2013, a charge €100 is levied in all facilities providing emergency out-patient services. In recent years, changes have been made to the emergency services provided in a number of hospitals with resultant changes in the description of the services from "an accident and emergency department". The Regulations cover out-patient services provided at an emergency department, a casualty department, a minor injury unit, an urgent care centre, a local injury unit or any other facility providing similar services.

Prescription Charges

Questions (682)

Alan Farrell

Question:

682. Deputy Alan Farrell asked the Minister for Health his views on the possibility of imposing a monthly cap on prescription charges in order to ensure that persons with multiple prescriptions are not discouraged from purchasing medication; and if he will make a statement on the matter. [22815/13]

Written answers

Minister of State at the Department of Health

Medical card holders are required to pay a €1.50 charge per item for medicines and other prescription items supplied to them by community pharmacists, subject to a cap of €19.50 per month for each person or family. Prescription charges do not apply to children in the care of the HSE or to methadone supplied to patients participating in the Methadone Treatment Scheme.

Disability Support Services Provision

Questions (683)

Alan Farrell

Question:

683. Deputy Alan Farrell asked the Minister for Health when the results action plan to reduce waiting times for assessing needs of children with disabilities will be realised; the factors that have contributed to a large number children waiting longer than six months for an assessment; and if he will make a statement on the matter. [22817/13]

Written answers

Minister of State at the Department of Health

Part 2 of the Disability Act 2005 was commenced on 1 June 2007 in respect of children aged under 5. In 2008, the then Government decided, in the light of financial circumstances, to defer further implementation of the Disability Act 2005 and the Education for Persons with Special Educational Needs Act 2004.

Part 2 of the Disability Act, inter alia, provides for an assessment of the needs of eligible applicants occasioned by their disability to be commenced within three months of receipt of an application and completed within a further three months.

There has been a very significant rise in overall activity around the assessment process in recent years in respect of the children now encompassed by the process. The number of assessment reports received in 2012 was 3,505 which is over 400 applications more than in 2010. It is worth noting that in the period 2010-2012 over 8,200 reports were completed. While the HSE recognises that it faces significant challenges in respect of meeting the statutory time-frames which apply to the assessment of need process given the number and complexity of cases, it is endeavouring to address the issue from available resources.

While any delay in assessment or intervention for any child is not desirable, the assessment process under the Disability Act can take place in parallel with any intervention which is identified as necessary. The HSE has issued guidance to its staff that where there is a delay in the assessment process, this should not affect the delivery of necessary and appropriate interventions identified for a particular child.

In addition targeted action plans have been put in place since early 2011. Measures have included: prioritising assessments, holding additional clinics, contracting the private sector to conduct assessments and reconfiguring resources to target areas of greatest need. These plans are monitored on a monthly basis by the HSE centrally.

Following the publication of a report commissioned from the National Disability Authority by the Department of Health and the Health Service Executive, a major emphasis is being placed on reconfiguring disability services for children into geographically-based early-intervention and school-aged teams as part of the Progressing Disability Services for Children and Young People Programme which is underway. The NDA report indicated that where integrated teams were operating, the assessment of need process ran more smoothly. It found that there was no one single solution to remove all of the challenges to operating a statutory assessment of need. A meeting involving the Department, the HSE and the NDA has been arranged for early June to discuss the Report further.

Special Educational Needs Services Provision

Questions (684)

Finian McGrath

Question:

684. Deputy Finian McGrath asked the Minister for Health if his attention has been drawn to the major collective effect of the cuts to personal assistants and the mobility allowance for children and adults with a disability; and if he will reverse these cuts. [22823/13]

Written answers

Minister of State at the Department of Health

The Government currently provides funding of over €1.5 billion to the Disability Services Programme, through the Health Service Executive's (HSE) National Service Plan for 2013 and is committed to protecting frontline services for people with disabilities to the greatest possible extent. The Minister for Health is working to ensure that protection is afforded to the disability sector, and the Social Care area as a whole. In 2013, the HSE is seeking to maximise the provision of services within available resources and to maintaining a consistent level to that provided in 2012, by continuing to provide 1.68m hours of Personal Assistant / Home Support Hours along with: - residential services to over 9,000 people with a disability; - day services to over 22,000 people with intellectual and physical disabilities; and - respite residential support for over 7,500 people with intellectual and physical disabilities.

The Government is very conscious of the needs of the people with disability who require transport supports from the State. The Government is also conscious of the position of the Ombudsman that the Mobility Allowance and Motorised Transport Grant schemes are illegal in the context of the Equal Status Acts. Following detailed consideration of issues surrounding the two schemes, the Government decided in February that it is no longer possible to allow the schemes to continue and to devise an alternative for meeting people's needs.

It is important to note that the decision is in no way intended to save costs and the funding involved in the two schemes (€10.6 million) remains committed to meeting the transport needs of relevant people. It is also important to note that despite the fact that both schemes ended in February, the payment of Mobility Allowance to those currently in receipt will continue until June, as we devise an alternative method of meeting people's needs.

A special Project Group, which is independently chaired, has been established to seek an alternative method to provide for the priority transport needs of people in a manner that does not run counter to the Equal Status Acts. The Project Group are to report to Government this month, before any final decisions are made on the future arrangements. At this stage, I am not in a position to pre-empt the outcome of the review or the decision of the Government.

Speech and Language Therapy

Questions (685)

Terence Flanagan

Question:

685. Deputy Terence Flanagan asked the Minister for Health under Health Service Executive guidelines, the number of hours of speech and language services per year which should be allocated to children with severe phonological disorders; and if he will make a statement on the matter. [22828/13]

Written answers

Minister for Health

The particular issue raised by the Deputy is a service matter for the Health Service Executive. Accordingly I have arranged for the question to be referred to the Health Service Executive for direct reply to the Deputy.

Hospital Staff

Questions (686)

Pádraig MacLochlainn

Question:

686. Deputy Pádraig Mac Lochlainn asked the Minister for Health if the Service Level Agreements between the Health Service Executive Medical Education and Training Unit and the College of Anaesthetists, the Royal College of Surgeons in Ireland and the Royal College of Physicians of Ireland require the colleges to ensure the fair and equal distribution of training posts for junior doctors to hospitals throughout the State reflects the service requirements of the HSE in hospitals across the State; and if he will make a statement on the matter. [22839/13]

Written answers

Minister for Health

As this is a service matter, it has been referred to the HSE for direct reply to the Deputy.

Hospital Staff

Questions (687)

Pádraig MacLochlainn

Question:

687. Deputy Pádraig Mac Lochlainn asked the Minister for Health if he is satisfied that the Health Service Executive's centralised recruitment process will deliver the required number of junior doctors to hospitals throughout the State this summer [22840/13]

Written answers

Minister for Health

The HSE is actively managing the recruitment process for the July 2013 rotation in order to ensure that as many NCHDs as possible are recruited and that all critical service needs are met. A number of separate recruitment processes are currently underway including: Filling by the Postgraduate Training Bodies of posts on training schemes; HSE Centralised Applications process; Local recruitment - which fills approximately 70% of service posts; Other external HSE funded initiatives - including a partnership arrangement with the College of Physicians and Surgeons of Pakistan and recruitment in South Africa.

In the longer term the HSE is focused on improving the working conditions of NCHDs and on measures that will improve retention and, in particular, the achievement of compliance with the European Working Time Directive. In this context the HSE has established a National Implementation Group to progress compliance with the requirements of the Directive and to facilitate introduction of electronic time recording and rostering systems.

Primary Medical Certificates Eligibility

Questions (688, 689)

Gerry Adams

Question:

688. Deputy Gerry Adams asked the Minister for Health the criteria for the purposes of application for primary medical certificates, and the process under which persons may appeal a decision made to refuse same; and if he will make a statement on the matter. [22842/13]

Gerry Adams

Question:

689. Deputy Gerry Adams asked the Minister for Health if he will consider an application for primary medical certificate in respect of persons (details supplied) in County Louth; if he will outline the reason for refusal of same; if there is recourse for these persons to appeal the decision in view of the medical conditions and associated mobility issues; and if he will make a statement on the matter. [22843/13]

Written answers

Minister of State at the Department of Health

I propose to take Questions Nos. 688 and 689 together.

The Revenue Commissioners' operate a Disabled Drivers and Disabled Passengers Scheme whereby a person with a disability or a family member can qualify for tax relief linked to the purchase of vehicles, providing the person with a disability is the holder of a Primary Medical Certificate. Applications for Primary Medical Certificates are processed by the Health Service Executive through local health offices.

The medical criteria for entry to the scheme, which are set out by the Department of Finance, are that the person with disability must be severely and permanently disabled and come within the following categories- Be wholly or almost wholly without the use of both legs; Be wholly without the use of one of their legs and almost wholly without the use of the other leg such that they are severely restricted as to the movement of their lower limbs; Be without both hands or without both arms; Be without one or both legs; Be wholly or almost wholly without the use of both hands or arms and wholly or almost wholly without the use of one leg; Have the medical condition of dwarfism and have serious difficulties of movement of lower limbs.

Where the issue of a Primary Medical Certificate is refused, the applicant may appeal this refusal to the Disabled Drivers Medical Board of Appeal, the National Rehabilitation Hospital, Rochestown Avenue, Dun Laoghaire, Co. Dublin. This is an independent Board, whose decision is final. Where the Board considers that the person concerned meets the criteria, it will issue the required certificate. It is of course open to the individual to re-apply for a Primary Medical Certificate should a change occur in his/her medical condition to the extent that the medical criteria may be met. I have referred the individual case raised by the Deputy to the Health Service Executive, for a direct reply to the Deputy.

Departmental Expenditure

Questions (690)

John McGuinness

Question:

690. Deputy John McGuinness asked the Minister for Health the individual amount of overtime paid in the case of each political or ministerial appointee for the period 2007 to date in 2013 relative to his office and the office of the Minister of State; if such payments were made to the Secretary General and advisers, and if so, the amounts for the same period. [22877/13]

Written answers

Minister for Health

The information in respect of the amount of overtime paid in the case of each political / Ministerial appointee for the period 2007 to date in 2013 is set out in the following table:

Minister / Minister of State	2007 to date in 2013
Minister James Reilly:	-
Personal Assistant	€14,148.67
Personal Secretary x 2	€4,581.15 + €1,914.98
Minister of State Roisin Shortall:	-
Personal Assistant	€14,153.14
Personal Secretary	€9,737.98
Minister of State Kathleen Lynch:	-
Personal Assistant	€4,490.17
Personal Secretary	€10,444.14
Minister of State AlexWhite:	-
Personal Assistant	€2,280.20
Personal Secretary	€3,023.40
Minister Mary Harney:	-
Personal Assistant	€1,559.56
Minister of State Barry Andrews:	-
Personal Secretary	€22,518.01
Personal Assistant	€32,374.72
Minister of State Aine Brady:	-
Personal Secretary	€5,376.07
Personal Assistant	€2,546.42
Minister of State John Moloney:	-
Personal Assistant	€29,970.63
Minister of State Maire Hoctor:	-
Personal Assistant	€20,006.02
Personal Secretary	€16,942.44
Minister of State Pat the Cope Gallagher:	-
Personal Secretary	€8,190.80
Minister of State Brendan Smith:	-
Personal Assistant	€7,871.34
Personal Secretary	€7,082.17
Minister of State Jimmy Devins:	-
Personal Assistant	€8,683.57
Personal Secretary	€5,402.51
Minister of State Brian Lenihan:	-
Personal Secretary	€8,759.36
Personal Assistant	€6,502.71
Minister of State Mary Wallace:	-
Personal Secretary	€3,269.39
Temporary Clerical Officer	€4,462.69
TOTAL:	€256,292.24

Neither the Secretary General nor the Special Advisors to Ministers / Ministers of State receive overtime.

Question No. 691 answered with Question No. 98.

Internet Safety Issues

Questions (692)

Billy Kelleher

Question:

692. Deputy Billy Kelleher asked the Minister for Health the action he will take against websites that promote harmful and unhealthy behaviour such as promoting anorexia and bulimia and other eating disorders; and if he will make a statement on the matter. [22918/13]

Written answers

Minister of State at the Department of Health

I wish to stress, in the first instance, that the Internet is an international and worldwide phenomenon, that has no borders and no single control mechanism. Therefore, efforts to combat harmful materials and activities on the Internet can be hampered by the multiplicity of jurisdictions, various legal systems, differing societal norms, or other relevant factors in this regard.

Many pro-eating disorder websites may be hosted outside this jurisdiction, principally in the United States. As such, they would be subject to US jurisdiction, and any effective action is therefore limited in nature. Notwithstanding such difficulties, there is in Ireland a self-regulatory framework in place for internet service providers (ISPs). The Internet Service Providers Association of Ireland Code of Practice and Ethics sets out clear guidelines and minimum standards in respect of dealing with complaints regarding suspected illegal material. However, pro-eating disorder websites are not regarded as illegal.

The Deputy may rest assured that the Department of Health, in conjunction with other relevant agencies, are cognisant of the issues raised in this instance and will continue to pursue an inter-agency response to policy and service developments to best tackle eating disorders overall. A key feature of this, obviously, is to promote awareness of the dangers involved among the younger sections of our population.

Question No. 693 answered with Question No. 120.

Health Services Staff Recruitment

Questions (694)

Dara Calleary

Question:

694. Deputy Dara Calleary asked the Minister for Health the reasons a national recruitment campaign for the PHNS service has been changed from an applicant who previously was able to choose three LHO areas and can now only choose one; the way the LHO areas were designated; his views on whether it is fair that existing candidates on the panel who applied on the basis of been able to select three areas are now forced to choose one; the position regarding the planned recruitment of LHOs in each region for 2013; and if he will make a statement on the matter. [22932/13]

Written answers

Minister for Health

As the recruitment of PHNs is a matter for the HSE, I have requested the Executive to respond directly to the Deputy concerning the issues he has raised.

Nursing Home Services

Questions (695)

Dan Neville

Question:

695. Deputy Dan Neville asked the Minister for Health the position regarding a rehabilitation bed in respect of a person (details supplied) in County Limerick; and if he will make a statement on the matter. [23011/13]

Written answers

Minister of State at the Department of Health

As this is a service matter it has been referred to the Health Service Executive for direct reply.

Generic Drugs Substitution

Questions (696)

Bernard Durkan

Question:

696. Deputy Bernard J. Durkan asked the Minister for Health the extent to which central procurement and generic prescribing have been each identified and assessed for potential to reduce health service costs without in any way affecting the quality and efficacy of the service; and if he will make a statement on the matter. [23012/13]

Written answers

Minister of State at the Department of Health

The Health (Pricing and Supply of Medical Goods) Bill 2012 provides for the introduction of a system of generic substitution and reference pricing. These reforms will promote price competition among suppliers and ensure that lower prices are paid for medicines resulting in savings for taxpayers and patients. The Bill passed Report Stage on the 9th of May and will return to the Seanad on the 22nd of May. It is hoped that the Bill will complete its passage through both Houses of the Oireachtas shortly thereafter. It is not possible, at this juncture, to provide accurate figures regarding potential savings resulting from the introduction of generic substitution and reference pricing, as these depend on various factors including prevailing prices, number of competitors, availability of substitute products, and market dynamics.

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 represents 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.

In addition, the recently established HSE Medicines Management Programme has identified ‘preferred drugs’ for prescribers when prescribing Proton Pump Inhibitors (PPIs) or statin medication for patients. This is the first time that the State has introduced a preferred drug initiative. PPIs are prescribed for patients with peptic ulcer disease and/or reflux and statin medication is for high cholesterol. The preferred PPI is Lansoprazole and the preferred statin is Simvastatin. The HSE is asking doctors to prescribe these preferred drugs in order to save money, both for patients who pay for their medication and to deliver savings of an estimated €15million for the taxpayer.

Furthermore, the European Commission has completed its eighth review of the EU-IMF financial assistance programme for Ireland and has published the technical report by the Directorate General for Economic and Financial Affairs (ECFIN) which assesses programme implementation by the Irish authorities. The report published on 28th January 2013 identifies areas where the joint EC-ECB-IMF mission considers that further efficiencies could be achieved in the health system. This includes compulsory prescription by active ingredient rather than by brand name with exceptions only for 'non-substitutability' cases. The implications of this recommendation are being examined by my Department at present.

Health Services, Cost of Medicines

Questions (697, 698)

Bernard Durkan

Question:

697. Deputy Bernard J. Durkan asked the Minister for Health the extent to which drug costs have fluctuated in each of the past five years to date; the way this has affected the budgetary situation; and if he will make a statement on the matter. [23013/13]

Bernard Durkan

Question:

698. Deputy Bernard J. Durkan asked the Minister for Health the extent to which a rise in costs of any particular or specific drugs has been identified over the past five years to date; and if he will make a statement on the matter. [23014/13]

Written answers

Minister of State at the Department of Health

I propose to take Questions Nos. 697 and 698 together.

The costs of drugs and medicines for the last 5 years are set out in the table below (corresponding figures for 2012 are not yet available).

-	2011 (000s)	2010 (000s)	2009 (000s)	2008 (000s)	2007 (000s)
Cost of Drugs and Medicines	€1,467,575	€1,533,619	€1,659,931	€1,595,089	€1,480,201

There has been a general price freeze in operation in Ireland for medicines since the mid 1990's. Price increases have only been allowed under the national pricing agreements in exceptional circumstances. Of the existing medicines reimbursed, in excess of 4,000 products have been impacted by price reductions since 2006.

Approximately 60 products have been granted price increases since 2006. Included in this are essential medicines such as epilepsy medicines and cortico-steroids. Price increases are only allowed in extremis to maintain supplies of required medicines in the Irish market and require the provision of detailed supporting evidence including international pricing. A number of the price increases were accompanied by pro-rata reductions in other products within a company’s portfolio (as per the national pricing agreements).

Price increases are not a significant contributor to reimbursement costs. Between 2009 and 2013 price reductions of the order of 30% per item reimbursed have been achieved. The average cost per item on the GMS Scheme has reduced from a peak of €18.97 in 2009 to €13.43 in January/February 2013, a 29% reduction in cost per item. The average cost per item reimbursed is now running at 2001/2002 levels.

Nursing Staff Numbers

Questions (699)

Bernard Durkan

Question:

699. Deputy Bernard J. Durkan asked the Minister for Health the total number of fully-qualified nurses employed in the public health sector in each of the past five years to date; the extent if any to which resignations, retirements or movement to the private sector has affected staff levels in the public sector; and if he will make a statement on the matter. [23015/13]

Written answers

Minister for Health

The total number of fully-qualified nurses employed in the public health sector in each of the past five years at end-March (latest figure available) is as set out in the following table:

Date	end-March 2009	end-March 2010	end-March 2011	end-March 2012	end-March 2013
Total WTE excl. Career Break	37,696	36,891	36,106	34,296	33,997

The 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. The HSE may continue to recruit nurses and midwives in exceptional circumstances where it has been established that there is an urgent service requirement and this can be accommodated within the budgetary and staff number limits in place. I have asked the HSE to respond directly to the Deputy in relation to the more detailed aspects of the question.

Nursing Assistant Numbers

Questions (700)

Bernard Durkan

Question:

700. Deputy Bernard J. Durkan asked the Minister for Health the total number of nursing assistants currently employed throughout the public health sector; the extent to which such numbers have fluctuated in the past five years; and if he will make a statement on the matter. [23016/13]

Written answers

Minister for Health

As this is a service matter it has been referred to the Health Service Executive for direct reply.

Orthodontic Services Provision

Questions (701)

Bernard Durkan

Question:

701. Deputy Bernard J. Durkan asked the Minister for Health the extent to which orthodontic services continue to be made available to children and teenagers with particular reference to follow-up on school medical examinations; and if he will make a statement on the matter. [23017/13]

Written answers

Minister of State at the Department of Health

The HSE provides orthodontic treatment to those who have been assessed and referred for treatment before their 16th birthday. Orthodontic referrals are generally received via the Public Dental Service school screening programme. An individual's access to orthodontic treatment is determined against a set of clinical guidelines called the Modified Index of Treatment Need. Patients with the greatest level of need, i.e. Grade 5 or Grade 4 are provided with treatment by the HSE.

Questions Nos. 702 and 703 answered with Question No. 116.