Thursday, 26 Sep 2013

Written Answers Nos. 29-41

Home Help Service Provision

Questions (29)

Brian Stanley

Question:

29. Deputy Brian Stanley asked the Minister for Health when the home help hours cut in 2012 will be restored; and if he will make a statement on the matter. [40046/13]

Written answers

Minister of State at the Department of Health

I have already indicated on a number of occasions that Home Help provision in 2013 has been restored to levels planned for in 2012.

Medicinal Products Prices

Questions (30)

Sandra McLellan

Question:

30. Deputy Sandra McLellan asked the Minister for Health the timeframe for the full roll-out of reference pricing and generic substitution; and if he will make a statement on the matter. [40048/13]

Written answers

Minister of State at the Department of Health

The Health (Pricing and Supply of Medical Goods) Act 2013, which came into operation on the 24th of June, introduces a system of generic substitution and reference pricing. This legislation will promote price competition among suppliers and ensure that lower prices are paid for these medicines resulting in further savings for both taxpayers and patients.

Under the Act, the Irish Medicines Board (IMB) is responsible for the assessment for interchangeability of medicines. Generic substitution will be introduced incrementally with the IMB prioritising those medicines which will achieve the greatest savings for patients and the State. The Board is in the process of reviewing an initial 20 active substances, which equates to approximately 1,500 individual medicines. They include statins, proton pump inhibitors, angiotensin-converting-enzyme (ACE) inhibitors and angiotensin II receptor blockers.

The first List of Interchangeable Medicines, containing groups of atorvastatin products, was published by the IMB on the 7th August. The second and third lists containing groups of esomeprazole and rosuvastatin products were published on 20th and 24th September respectively. It is expected that the initial list of 20 priority products will have been assessed by the IMB by June 2014. At this point a further list of priority products will be identified and assessed by the IMB and the process will continue until all medicinal products on the reimbursable list have been assessed.

Once a List of Interchangeable Medicines is published by the IMB a two stage price reduction process gets underway. First, under the terms of the 2012 APMI Agreement, the price of all relevant products fall by 20%, e.g. Atorvastatin prices were reduced from 1st September. Secondly, the legislation also provides that the HSE may set a reference price for each group of interchangeable products published on the List of Interchangeable Products with a view to introducing further significant price cuts.

Reference pricing involves the setting of a common reimbursement price, or reference price, for a group of interchangeable medicines. It means that one reference price is set for each group or list of interchangeable medicines, and this is the price that the HSE will reimburse to pharmacies for all medicines in the group, regardless of the individual medicine’s prices. It is expected that the first reference price for atorvastatin products will be implemented by November and, subsequently, reference prices for esomeprazole and rosuvastatin products will be implemented by the HSE in accordance with the timelines set out in the legislation. Reference prices will ensure that generic prices in Ireland will fall towards European norms.

Home Help Service Eligibility

Questions (31)

Pádraig MacLochlainn

Question:

31. Deputy Pádraig Mac Lochlainn asked the Minister for Health if it is the case that he intends to introduce means testing for home care and other services for older persons and persons with disabilities; and if he will make a statement on the matter. [40042/13]

Written answers

Minister of State at the Department of Health

No decisions of this nature have been taken.

In line with what we committed to in the Programme for Government, we have commenced a review of the Nursing Homes Support Scheme. This review will consider the scheme's administration and structures, and also its sustainability in the longer term.

The review will consider the balance of funding between long-term residential care and community based services and the options that may exist for the future financing of community based services and of disability and mental health services. Work will continue on the review in the coming months with a view to completion by end 2013-early 2014. Primary legislation is likely to be needed to implement any changes resulting from this review.

The Value for Money and Policy review of disability services echoes Future Health - a Strategic Framework for Reform of the Health Service 2012-2015 in recommending the need to restructure service delivery, and improve organisational, financial, governance and accountability systems with the aim of providing a more effective and more accountable service. One of the recommendations of the VFM Review is to move towards a model of individualised budgeting, whereby individuals and their families will be given more choice and control over the service and supports they require. Any such model will have to be carefully considered and under-pinned by a resource allocation provision which will take account of peoples' needs and circumstances against a defined resource cap.

Hospital Services

Questions (32)

Jonathan O'Brien

Question:

32. Deputy Jonathan O'Brien asked the Minister for Health the measures he is taking to address the waiting lists for rehabilitation services; and if he will make a statement on the matter. [40053/13]

Written answers

Minister of State at the Department of Health

I understand that the Deputy is referring to services at the National Rehabilitation Hospital (NRH) in Dun Laoghaire.

The NRH is working in partnership with the Health Service Executive (HSE) to deliver complex rehabilitation services in line with the National Policy and Strategy for the Provision of Neuro-Rehabilitation Services in Ireland 2011-2015. Services are developed on a regional basis in addition to the complex rehabilitation services currently being provided by the NRH. In this regard, the NRH and the HSE are working together to develop inpatient rehabilitation services and capacity in each region.

In addition, as part of the National Clinical Programme, the NRH is currently developing care bundles and clearly defined pathways for patients requiring inpatient services.

In May 2012, my colleagues the Tánaiste and the Minister for Health confirmed a significant capital development on the campus of the existing hospital. This development is a partnership between the HSE and the NRH Foundation and will see the existing facility at the NRH replaced by a new 120 bed ensuite facility including integrated therapy service and will represent an increase of 9% in bed capacity.

This facility will be purpose built specifically to accommodate the needs of those requiring complex specialist rehabilitation services complying with best international practice and the Strategy for the Control of Antimicrobial Resistance in Ireland (SARI).

Domestic Violence Refuges

Questions (33)

Mick Wallace

Question:

33. Deputy Mick Wallace asked the Minister for Health the way the Health Service Executive proposes to deal with the current crisis in the provision of domestic violence services which has recently resulted in the downgrading of services at Wexford women's refuge; his plans to increase the HSE's funding for the provision of such services in view of the fact that Ireland currently only provides one third of the EU-recommended refuge places; and if he will make a statement on the matter. [40059/13]

Written answers

Minister for Health

Wexford Women's Refuge is a Limited Company run by a voluntary Board of Management. While the HSE commission the service of the Wexford women's refuge through a service level agreement, it is the voluntary Board of Management who are legally responsible for any decisions that are made in relation to how the service is delivered.

The reduction in service provision in Wexford Women's Refuge was based on a decision taken by the Board of Management to reduce services for 13 weeks. The decision is based on ensuring the long term sustainability of the service while working within a realistic budget as the Refuge has had a reduction in HSE funding over the past 5 years similar to other organisations. The plan will enable the refuge to continue to provide outreach and drop in services to the end of December 2013. While there is a reduction in service provision it is important to note that there is no reduction in funding from the HSE to the service in 2013 other than 2.5% which is in line with other government cuts. It is within this context that the voluntary Board of Management has been working in partnership with the staff, Trade Unions and funding agencies to devise a plan that will ensure the long term sustainability and delivery of the service to women and children in Wexford. The voluntary Board of Management is committed to ensuring that there continues to be a Refuge in Wexford. They are working in partnership with the other relevant bodies to overcome the immediate challenges and are confident that a Refuge service will continue to be available in Wexford once the current difficulties are addressed. HSE Children and Families Services are committed to supporting the Board in their efforts to develop this plan in partnership with staff, management and the Local Authority.

The National Strategy on Domestic, Sexual and Gender-based Violence was published in 2010. It aims to provide a framework for sustainable intervention to prevent and effectively respond to domestic, sexual and gender-based violence and is lead by Cosc which is the National Office for the Prevention of Domestic, Sexual and Gender-based Violence. In relation to Ireland providing only one third of EU recommended places I would like to refer the Deputy to a COSC publication 'Domestic and Sexual Violence Services in Ireland: Service Provision and Co-ordination' which states "In 2007, the levels of domestic and sexual violence services in Ireland satisfied the criteria established by the Council of Europe" (Page 68, section 3.7).

Nursing Homes Support Scheme Oversight

Questions (34, 42, 54)

Sandra McLellan

Question:

34. Deputy Sandra McLellan asked the Minister for Health if it is within his power by means of regulations, or if legislation is needed, to require private and voluntary nursing homes who are in the nursing home support scheme to provide a minimum number of places for higher dependency patients in order to avoid cherry-picking by these homes, resulting in higher dependency patients remaining at the back of the queue for places; and if he will make a statement on the matter. [40047/13]

Michael Colreavy

Question:

42. Deputy Michael Colreavy asked the Minister for Health the action he will take to maintain and upgrade public nursing home facilities to meet the Health Information and Quality Authority standards, to invest sufficiently to do so and to ensure that the public nursing home sector is enhanced, in view of the growing need for, and overall shortage of, nursing home beds and the over-reliance on private nursing home provision, leading to cherry-picking by private providers with higher dependency applicants for nursing home places left at the back of the queue. [40033/13]

Thomas Pringle

Question:

54. Deputy Thomas Pringle asked the Minister for Health the steps he is taking to provide for increased public beds in community hospitals in order to prepare for the doubling of the over 65 population here over the next ten years; and if he will make a statement on the matter. [40062/13]

Written answers

Minister of State at the Department of Health

I propose to take Questions Nos. 34, 42 and 54 together.

Government policy is to support older people to live in dignity and independence in their own homes and communities for as long as possible. Where this is not feasible, the health service supports access to appropriate quality long-term residential care. Access to appropriate quality long-term residential care is underpinned by both the system of registration and inspection of nursing homes and the financial support available under the Nursing Homes Support Scheme.

The Department is working closely with the Health Service Executive to develop an overall plan regarding future public provision of long-stay residential care services. The plan will reflect both national and regional requirements and will have regard to the current severe financial constraints, restrictions on public sector staffing and recruitment and the on-going need to meet service and safety standards, all of which pose challenges for community nursing units across the country.

The review of the Nursing Homes Support Scheme will also influence the future direction of residential care services. This review will consider the long-term sustainability of the Scheme as well as looking at the community based services. Work on the review is on-going and it is expected that the review will be completed in late 2013 or early 2014. A longer-term plan for public residential facilities is therefore expected to be completed by approximately mid-2014 following completion of the review of the Scheme.

The Health Act 2009 (Care and Welfare of Residents in Designated Centres for Older People) Regulations 2009 provide that each nursing home must have a Statement of Purpose. The Statement of Purpose must include details of the range of needs that the designated centre is intended to meet. It would be inappropriate for the Minister for Health to require all private and voluntary nursing homes to provide a minimum number of places for higher dependency patients because the nursing homes may not be able to adequately cater for needs of the residents.

Our aim is to ensure that people are being cared for at the point of lowest complexity. People should only be entering long-term nursing home when this becomes absolutely necessary. This means that only the most dependent people should be in long-term nursing home care. One of the key priorities identified in the HSE's National Operational Plan 2013 is the progression of a single assessment tool for older people. This standardised framework will ensure that there is a robust, equitable standardised care needs assessment nationally. It will also allow resources to be targeted towards those with the greatest needs and enable supports and services to be designed in the most appropriate way possible.

Home Care Packages

Questions (35)

Michael McGrath

Question:

35. Deputy Michael McGrath asked the Minister for Health his plans to introduce paediatric care packages for children with life-limiting conditions; and if he will make a statement on the matter. [40017/13]

Written answers

Minister of State at the Department of Health

The issue of the provision of home care packages for children with life-limiting conditions is complex, encompassing those requiring short to medium-term care, those with a disability requiring long-term care and also sick children for whom there is no reasonable hope of a cure and who are expected to die.

Palliative Care for Children with Life-limiting Conditions in Ireland – a National Policy (2010) provides the foundation and clear direction for the development of an integrated palliative care service for children and their families, across all care settings.

Following its publication the National Development Committee for Children’s Palliative Care (NDC) was established by the HSE to oversee the implementation of the national policy. Membership includes statutory, professional, parent and voluntary representatives, including the IHF, Lauralynn and The Jack & Jill Foundation. The NDC has commenced working in partnership with these providers to develop a model for the provision of Hospice at Home care.

In 2012 HSE spent approximately €8.58m on home nursing for children with life-limiting conditions. It is widely acknowledged that this did not capture all relevant expenditure, which is significantly higher. It is also acknowledged that children with life-limiting conditions, particularly palliative care needs, are prioritised. Every effort is made to provide care to the maximum extent possible, including home care for them and their families.

The HSE is committed to proper governance, that care provided is clinically sound and that those providing care are adequately trained. A suitable national programme of continuing professional education has been established in partnership with the HSE, IHF and Crumlin Children’s Hospital. A working group has been established in HSE Dublin Mid-Leinster to restructure the financial system so that relevant expenditure is effectively accounted for. This will be replicated across all regions.

Eight children’s Outreach Nurses are in place in throughout the country to facilitate a co-ordinated support structure for children and families. They will identify the needs of each child and link families to appropriate local services.

The first Consultant Paediatrician with a Special Interest in Paediatric Palliative Medicine has been appointed to Crumlin Hospital and is available to provide an advisory service to other paediatric and maternity hospitals.

Obesity Strategy

Questions (36)

Clare Daly

Question:

36. Deputy Clare Daly asked the Minister for Health the initiatives he intends to undertake to deal with serious obesity levels here. [39922/13]

Written answers

Minister for Health

Comprehensive, multi-level approaches are required to address the obesity epidemic. For this reason the Minister for Health has established a Special Action Group on Obesity (SAGO) whom he meets with regularly to progress the obesity prevention agenda. SAGO is concentrating on a range of measures and initiatives to help reverse the growing prevalence of obesity in the Irish population.

Calorie posting has already commenced in a number of establishments and it is envisaged that in the coming months, when the necessary implementation mechanism has been devised it will be further implemented. There is strong support for the calorie posting in restaurants initiative among the general public and also, in fact, within much of the food industry itself.

Healthy Eating Guidelines were launched in 2012 which will help inform people about the food and drink choices required for a healthy lifestyle and set out in plain and simple language the food servings the Irish population need to consume to maintain health and wellbeing.

A Health Impact Assessment on the health and economic aspects of introducing a Sugar Sweetened Drinks tax was completed and presented to the Minister for Health and SAGO has recently established a sub-committee to investigate and develop a range of options to support healthy eating.

The Department of Health has worked with the Broadcasting Authority of Ireland, with regard to the marketing of food and drink to children towards a new Children’s Code up to 18 years, to restrict marketing of high fat, high salt and high sugar foods and drinks up to 7pm.

Treatment algorithms inform primary care staff of the steps to be taken with regard to managing obesity. Both ‘adult’ and ‘child’ algorithms have been agreed with health care professionals and are now available.

Research is underway in association with the Department of Children and Youth Affairs to establish the use and types of foods and drinks stocked in vending machines in post primary schools. SAGO has met with The Food and Drink Industry Ireland (FDII).

A key feature of the development of Healthy Ireland was engagement and collaboration across Government Departments. Such collaboration will continue to be a significant feature of the implementation strategy, which is now focused on, among other things, the development of an outcomes framework and a National Physical Activity Plan.

Question No. 37 answered with Question No. 6.

Vaccination Programme

Questions (38)

Dessie Ellis

Question:

38. Deputy Dessie Ellis asked the Minister for Health the supports he has provided and will provide to persons who contracted narcolepsy as a result of being vaccinated by the flu vaccine Pandemrix; if he will provide a full medical card in each case, access to international medical expertise, access to new drug treatments where appropriate, the official recognition of narcolepsy as a disability; and if he will make a statement on the matter. [40037/13]

Written answers

Minister for Health

I would like to assure the Deputy that addressing the health needs of those affected by narcolepsy, with symptom onset post pandemic vaccination, continues to be a priority for my Department. This includes consideration of all possible supports which may need to be put in place for those diagnosed. I, along with officials of my Department continue to work closely with the Health Service Executive and the Department of Education and Skills to ensure that a range of supports and services are available to address the needs of this group.

The Health Service Executive has responsibility for health service delivery, and at my request, have developed a range of measures including access to rapid diagnosis, clear treatment pathways, and reimbursement of expenses incurred. This includes expenses for counselling services for individuals and also for families of children affected by narcolepsy following pandemic vaccination, in cases where such services are not already availably through the HSE. Medical Cards have been provided to all those diagnosed and in line with the legislation and protocols these are required to be reviewed periodically.

Multi-disciplinary assessment which allow for appropriate individualised health and educational supports are ongoing. The National Educational Psychological Service (NEPS) is also engaging with the HSE and with the individual schools and parents of children concerned to identify and provide educational supports for the children and adolescents affected.

There are a number of definitions of disability that are used for particular purposes (e.g Disability Act, Education for Persons with Special Education Needs Act, Equal Status Act, Employment Equality Acts 1998 and 2004, the Census, and qualifying criteria for income supports such as Domiciliary Care Allowance, disability allowance etc). These definitions define disability in terms of an individual's functional ability in their environment rather than medical diagnosis or condition.

Health Services Expenditure

Questions (39, 260, 261)

Bernard Durkan

Question:

39. Deputy Bernard J. Durkan asked the Minister for Health the extent to which any budgetary overruns have occurred throughout the health service; the precise areas which have shown such overruns; when any such overruns became obvious monthly or otherwise since January last; if any particular action is merited to address any such recurrences in the future; and if he will make a statement on the matter. [40055/13]

Bernard Durkan

Question:

260. Deputy Bernard J. Durkan asked the Minister for Health the degree to which he and his Department continues to monitor expenditure overruns in all areas throughout the health service; the extent to which those areas most prone to such have been identified and the likely remedial action; and if he will make a statement on the matter. [40295/13]

Bernard Durkan

Question:

261. Deputy Bernard J. Durkan asked the Minister for Health the extent to which he and his Department has curtailed expenditure overruns throughout the service; and if he will make a statement on the matter. [40296/13]

Written answers

Minister for Health

I propose to take Questions Nos. 39, 260 and 261 together.

There is ongoing and intensive engagement each month between officials of my Department and the HSE in the context of regular monitoring of expenditure. My Department also provides detailed analysis each month on expenditure trends to the Department of Public Expenditure and Reform, and there is regular engagement between officials from that Department, my Department and the HSE. The HSE's Performance Report, which is published every month, provides an overall analysis of key performance data from Finance, HR, Hospital and Primary & Community Services. The activity data reported is based on Performance Activity and Key Performance Indicators outlined in the HSE National Service Plan. The June Performance Report, which is the most recent report available, is published on the HSE's website - www.hse.ie

Based on the most recent review of financial data, the HSE is not flagging any new concerns beyond those which were set out within the National Service Plan 2013 (NSP) as approved by me in January this year.

The projected outlook, as set out in the June Performance Report, is indicating a projected deficit of €104m in direct services, of which €75m is in Hospitals. Outside of this, the primary risks lie in PCRS, Child & Family Agency, PHI Legislation and the Haddington Road Agreement.

Cost containment plans are under review. The Executive is pro-actively engaged on internal efforts to address slippage in cost containment plans and to ensure that additional measures are identified and safely implemented to mitigate the projected deficits which are within HSE direct control, while engaging on an ongoing basis with my Department. The Chief Financial Officer has informed me that a number of site visits are underway, particularly where underperformance has been identified.

Commencement of Legislation

Questions (40)

Peter Mathews

Question:

40. Deputy Peter Mathews asked the Minister for Health the timeline for the operation of the Protection of Life During Pregnancy Act; and if he will make a statement on the matter. [39926/13]

Written answers

Minister for Health

The Protection of Life During Pregnancy Bill was signed into law by the President on 30th July 2013.

There are operational issues which need to be addressed before it can be commenced and the Department is liaising with the HSE in this regard. These include the establishment of a panel of medical practitioners for the purpose of the formal medical review provisions and administrative facilities to enable the review committee, drawn from the review panel, to perform its functions.

The Act will be commenced as soon as is practicable.

Health Services Charges

Questions (41)

Richard Boyd Barrett

Question:

41. Deputy Richard Boyd Barrett asked the Minister for Health if cancer patients who have to pay for their own treatment also have to pay for cancer-related surgery. [40066/13]

Written answers

Minister for Health

Under the provision of the Health Act 1970, a person with full eligibility (i.e. a medical card holder) is eligible for public hospital out-patient and in-patient services, including consultant services, without charge.

A person with limited eligibility (i.e. a non-medical card holder) is entitled, subject to certain charges, to all in-patient public hospital services in public wards including consultant services and out-patient public hospital services including consultant services. The current public hospital statutory in-patient charge is €75 per night subject to a maximum of €750 in any period of 12 consecutive months. Attendance at accident and emergency department is subject to a charge of €100 where the patient does not have a referral note from his/her doctor. This charge applies only to the first episode of care.

Under the Health Acts, a person can also opt to be private to their consultant for out-patient and in-patient services. In doing so they are liable for the fees of all consultants involved in their care. Private consultant fees are a private contractual matter between the consultant and their patient. In addition, patients opting to be private to their consultant for the purposes of in-patient services in public hospitals are also liable for the daily private accommodation charges directed by the Minister under Section 55 of the Health Act 1970 (as amended): a maintenance charge and a daily charge. The maintenance charge ranges from €586 to €1,046 per day for private patients who are accommodated in a private designated bed. The private in-patient daily charge is €75 and is applicable to all private patients without exception.