Written Answers Nos. 1030-1051
1030. Deputy Gerald Nash asked the Minister for Health when he will bring proposals in relation to the Walsh Report with regard to symphysiotomy to Government; when he will appoint a judge to meet with the women involved in order to facilitate a process to bring matters with regard to symphysiotomy further to a successful conclusion; and if he will make a statement on the matter. [45646/13]
View answerAs the Deputy may be aware, I received the independent report by Professor Oonagh Walsh on Symphysiotomy in Ireland at the end of May 2013 and the Report is under consideration.
I met with the three support groups representing the women concerned in August 2013. At that meeting, I proposed to appoint a judge to meet with the women in order to facilitate decisions on how best to bring closure for the women concerned.
My officials are actively considering this issue and I intend bringing proposals to Government as soon as possible.
I wish to confirm that I intend to publish the Walsh report when I have received Government approval regarding how best to proceed in relation to this issue.
My priority continues to be to ensure that the women who have had this procedure have their health needs comprehensively and professionally met. In this regard, the HSE provides a range of services to women who may be experiencing any adverse effects as a result of undergoing this procedure. These services include the provision of medical cards, the availability of independent clinical advice and the organisation of individual pathways of care and the arrangement of appropriate follow-up.
1031. Deputy Nicky McFadden asked the Minister for Health if he will provide an update on progress in relation to the proposed business plan by the Health Service Executive and Beaumont Hospital to introduce a bilateral cochlear implant programme; and if he will make a statement on the matter. [45651/13]
View answerBeaumont Hospital is the centre for delivering Ireland’s national cochlear implant programme, with surgical provision for patients under six years being carried out in the Children’s University Hospital Temple Street. Since the programme commenced in 1995, over 700 patients have received cochlear implants. Beaumont Hospital carried out ninety cochlear implants in 2012 (42 children and 48 adults).
The HSE has developed a proposal, in liaison with Beaumont Hospital, to introduce a bilateral cochlear implant programme in Ireland. It is planned that the programme will be located in Beaumont Hospital. This is a complex development and the HSE has engaged with many stakeholders in the proposal development. Introduction of bilateral cochlear implantation will involve additional staff, equipment and capital works and will be dependent on additional funding being made available to support its commencement. The proposal is being considered in the context of the Health Estimate for 2014, announced on 15 October last, and the development of the HSE's National Service Plan 2014.
1032. Deputy Terence Flanagan asked the Minister for Health the reason those applying for terminal medical cards are now being asked for information regarding their financial circumstances; and if he will make a statement on the matter. [45661/13]
View answerUnder the Health Act 1970, as amended, the HSE is responsible for assessing an individual's entitlement to a medical card and a GP visit card. The legislation provides that persons who, in the opinion of the HSE are unable, without due hardship, to arrange general practitioner medical and surgical services for themselves and their dependents are deemed to be persons with full eligibility.
Medical card eligibility is granted to persons on the basis of a notification having being received confirming a diagnosis of terminal illness and that the person concerned is at the end stage of that illness. No means test is applied to a person reporting end stage terminal illness.
On receipt of the report confirmation, a medical card issues within 24 hours to the person concerned for a period of six months. Moreover, it is open to the person concerned or their parents, in the case of a card issuing to a child, to make a full application for medical card eligibility before the expiry of the initial six month period of eligibility. In any event, renewal assessment forms automatically issue to the holders of all medical card or GP visit cards, three months prior to the expiry date of the card.
1033. Deputy Seán Crowe asked the Minister for Health his views on whether there are sufficient general practitioner services in Monasterevin, County Kildare, for a population of over 3,000. [45687/13]
View answerAs this is a service matter, it has been referred to the Health Service Executive for direct reply to the Deputy.
1034. Deputy Seán Crowe asked the Minister for Health the reason there are substantial waiting times for patients to see Health Service Executive speech and language therapists in County Kildare and south Dublin [45688/13]
View answerAs this is a service matter, it has been referred to the Health Service Executive for direct reply to the Deputy.
1035. Deputy Kevin Humphreys asked the Minister for Health when the rehabilitation training will be provided in respect of a person (details supplied) in Dublin 6 as funding has been allocated but it is now over seven weeks since the beginning of September and they require administrative sign off from the Health Service Executive; and if he will make a statement on the matter. [45657/13]
View answerAs the Deputy's question relates to service matters I have arranged for the question to be referred to the Health Service Executive for direct reply to the Deputy.
1036. Deputy Tom Fleming asked the Minister for Health if he will expedite a medical card appeal in respect of persons (details supplied) in County Kerry; and if he will make a statement on the matter. [45662/13]
View answerThe Health Service Executive has been asked to examine this matter and to reply to the Deputy as soon as possible.The Health Service Executive operates the General Medical Services scheme, which includes medical cards and GP visit cards, under the Health Act 1970, as amended. It has established a dedicated contact service for members of the Oireachtas specifically for queries relating to medical cards and GP visit cards, which the Deputy may wish to use for an earlier response. Contact information has issued to Oireachtas members.
1037. Deputy Terence Flanagan asked the Minister for Health if there is a policy change in his Department or whether the regulations regarding the issuing of terminal medical cards is now being fully implemented; the number of terminal medical cards issued over the past year; the total amount; the total versus last years number; and if he will make a statement on the matter. [45663/13]
View answerThere has been no change to the policy or the regulations regarding the issuing of medical cards to terminally ill patients.
The HSE has an effective system in place for the provision of emergency medical cards for patients who are terminally ill, or who are seriously ill and in urgent need of medical care that they cannot afford. They are issued within twenty-four hours of receipt of the required patient details and the letter of confirmation of the condition from a doctor or a medical consultant. With the exception of terminally ill patients, the HSE issues all emergency cards on the basis that the patient is eligible for a medical card on the basis of means or undue hardship, and that the applicant will follow up with a full application within a number of weeks of receiving the emergency card. As a result, emergency medical cards are issued to a named individual, with a limited eligibility period of six months.
For persons with a terminal illness in palliative care, no means test applies. Once the terminal illness is verified, patients are given an emergency medical card for six months. Given the nature and urgency of the issue, the HSE has appropriate escalation routes to ensure that the person gets the card as quickly as possible.
The information sought by the Deputy, concerning the number of medical cards issued to persons with a terminal illness in palliative care, is not readily available. However, I have asked the Health Service Executive to supply this information to me and I will forward it to the Deputy as soon as possible.
1038. Deputy Terence Flanagan asked the Minister for Health the criteria that needs to be met to receive a terminal medical card, a discretionary medical card or an emergency medical card; and if he will make a statement on the matter. [45664/13]
View answerAn emergency medical card can be requested from the HSE in respect of 1) A person in palliative care, who is terminally ill; 2) A homeless person in need of urgent medical care; 3) A person with a serious medical condition that is in need of urgent medical care; 4) A foster child in need of urgent medical care; 5) An asylum seeker with a serious medical condition who is in need of urgent medical care.
No means test is applied to a person presenting with the above emergency circumstances. All that is required is that a medical report be submitted to the HSE verifying the person's circumstances as above. On receipt of the report confirmation, a medical card issues within 24 hours to the person concerned for a period of six months.
The 1970 Health Act states that persons who are unable, without undue hardship, to arrange GP services for themselves and family qualify for a medical card, having regard to the overall financial situation of the applicant and his/her dependants. Applications are, in the first instance, subject to a means assessment to determine if assessable income declared is within the set income limits to qualify for a medical card or a GP visit card. Medical card and GP visit card applications are considered in accordance with the Medical Card and GP Visit Card National Assessment Guidelines.
If an application is assessed over the qualifying financial thresholds for both a medical card and GP visit card or assessed as under the qualifying thresholds for a GP visit card only, and the application also includes other medical, social or financial details that do not form part of the means assessment, the application will then be considered on discretionary grounds for a grant of a card under the provisions relating to "undue hardship"/"unduly burdensome’ to arrange GP services for the medical card scheme of assessment. The assessment to be made in this instance is whether it is considered that ‘undue hardship’ will occur or an ‘undue burden’ be placed on the applicant(s) in providing for his/her medical needs or his/her family dependants’ medical needs in the absence of medical card or GP visit card eligibility.
The National Assessment Guidelines provide guidance to a decision maker as to the relevant factors to have regard to in making an assessment as to whether the ‘undue hardship’/’undue burden’ provisions apply to the circumstances presented on an application. In particular, the guidelines state that the ‘exercise of discretion by the HSE, in favour of the applicant, should be considered where meeting the costs of services covered by a Medical Card or a GP Visit Card compromises the applicant’s or his/her family’s ability to meet the essential costs associated with maintenance of employment; provision of reasonable housing; provision of appropriate nurturing and care for children or dependants; provision of adequate heating, nutrition and clothing, or coping with exceptional personal and financial burdens arising from medical or social circumstances. In conducting this assessment, the Guidelines state that the following issues be taken account of on an application illness or medical circumstances which results in financial hardship; the cost of providing general medical and surgical services; the cost associated with the provision of medical, nursing and dental treatment; the cost of physiotherapy and speech and language therapy; transport cost to hospitals and clinics; addictions such as drink, drugs and gambling; poor money management; social deprivation – including poor home management; the cost of medical aids and appliances.
The HSE will give equal consideration to each of the above factors that present on an application in deciding whether to approve that application for grant of a medical card on grounds of ‘undue hardship’/’undue burden’.
The decision maker may make appropriate inquires or seek advice from other sources to assist with coming to a decision on ‘undue hardship’/’undue burden’; these sources may include the Applicant’s Doctor(s); the HSE’s Medical Officers; the Public Health Nurse; the Community Welfare Officer; social Worker; therapy Services; and the Money Advice and Budgeting Service (MABS).
1039. Deputy Gerald Nash asked the Minister for Health when a paediatric urologist will be appointed to Temple Street Childrens Hospital; and if he will make a statement on the matter. [45704/13]
View answerThe Children's University Hospital, Temple Street is the national tertiary care centre for spina bifida and hydrocephalus. All infants born in Ireland with spina bifida are transferred to Temple Street after birth for ongoing neonatal management. Children with spina bifida are seen by a multidisciplinary team at Temple Street which includes a Consultant Paediatrician with a special interest in spina bifida, a spina bifida nurse specialist and neurosurgery input. It is intended to recruit a consultant urologist in order to ensure dedicated urology input. A recruitment process took place in 2009/2010 and again in 2012/2013. As neither was successful, a new recruitment process is now in train and I am advised that the HSE is hopeful that this new recruitment process will result in a suitable candidate taking up the post.
1041. Deputy Terence Flanagan asked the Minister for Health his plans to deliver medical cards to all children under five years of age; and if he will make a statement on the matter. [45707/13]
View answerThe Government is committed to introducing, on a phased basis, a universal GP service without fees within its term of office, as set out in the Programme for Government and the Future Health strategy framework. As announced in the Budget, it has been decided to commence the roll-out of a universal GP service by providing all children aged 5 and under with access to a GP service without fees. This will mean that almost half of the population will have access to GP services without fees. The Government is providing new, additional funding of €37 million to meet the cost of this measure.
The implementation of this measure will require primary legislation. The necessary administrative arrangements will be made during the course of 2014 when the specifics of the legislation are known.
The introduction of a universal GP service constitutes a fundamental element in the Government's health reform programme. The current Government is the first in the history of the State to have committed itself to implementing a universal GP service for the entire population. A well functioning health system should provide equal access to health care for its patients on the basis of health needs, rather than ability to pay. The principles of universality and equity of access mean that all residents in Ireland should be entitled to access a GP services that is free at the point of use.
1042. Deputy Thomas P. Broughan asked the Minister for Health the health sevices and supports that are in place to support children and adults who have been diagnosed with Ehlers-Danlos syndrome [45717/13]
View answerAs this is a service matter it has been referred to the HSE for direct reply to the Deputy.
1043. Deputy Éamon Ó Cuív asked the Minister for Health the funding provided for the disability sector in 2013 and the proposed funding for 2014 based on the estimates presented to Dáil Éireann as part of the budget process; the amount of new funding that will be provided next year for school leavers; the way it is intended to ensure full services for persons with a disability in 2014; and if he will make a statement on the matter. [45748/13]
View answerThis Government currently provides funding of over €1.5 billion to the Disability Services Programme through the HSE’s National Service Plan for 2013, and is committed to protecting front-line services for people with disabilities to the greatest possible extent.
In 2013 the HSE is seeking to maximise the provision of services within available resources and is committed to maintaining a consistent level to that provided in 2012, by providing the following specialist disability services residential services to over 9,000 people with a disability; day services to over 22,000 people with intellectual and physical disabilities; respite residential support for over 7,500 people with intellectual and physical disabilities; 1.68m hours of Personal Assistant / Home Support Hours.
Pending the completion of the HSE's National Service Plan for 2014, it is not possible to predict the service levels and funding to be provided next year for the disability sector including the funding that will be available for school leavers.
1044. Deputy Ciara Conway asked the Minister for Health the reason for the delay in the Health Service Executive paediatric psychology service (detail supplied); the reason families are being told they will have to wait for four years for an appointment; the steps being taken to address this issue; and if he will make a statement on the matter. [45749/13]
View answer1068. Deputy Billy Kelleher asked the Minister for Health the reason families in County Wexford are waiting up to four years for an appointment to see someone from the Health Service Executive Paediatric Psychology Services and the measures he is taking to rectify the situation; and if he will make a statement on the matter. [45996/13]
View answerI propose to take Questions Nos. 1044 and 1068 together.
Significant resources have been invested by this country in recent years in services for children with disabilities, including those with autism. The Government is committed to the provision and development of services for these children, having regard to available resources.
As the Deputy will be aware, the Health Service Executive is currently engaged in a national programme of reconfiguring therapy resources for children with disabilities, including autism, with a view to ensuring there is more equitable access to services for children, according to their individual needs. Established since 2010, the national re-configuration programme is based on the recommendations of the Report of the National Reference Group on Multidisciplinary Disability Services for Children aged 5-18.
A key objective of the HSE’s Progressing Disability Services for Children and Young People Programme (0-18 years ) is to ensure there is a clear pathway for all children to the services they need regardless of where they live, what school they go to or the nature of their disability or developmental delay. In practical terms this means that health professionals and parents will know exactly where a child should be referred and how to refer them. A fundamental principle underlying the Programme is that children should receive the health services they need as close to their home and school as possible. Some children may have their needs met by their local primary care services. An Early Intervention Team and a School Age Team will look after all children with more complex needs in a defined geographic network area, regardless of the nature of their disability. These Teams will be supported by specialist services in areas requiring a high level of expertise. The Programme supports the principle of providing access to mainstream education where appropriate while also recognising a continuing role for special schools.
The specific issue of waiting times for therapy services is an operational matter for the Health Service Executive. Accordingly I have arranged for these questions to be referred to the Health Service Executive for direct reply to the Deputies.
1046. Deputy Billy Kelleher asked the Minister for Health if the criteria he uses for measuring waiting times in emergency Departments are comparable internationally; and if he will make a statement on the matter. [45762/13]
View answerThere are no international norms or agreed standards regarding total ED times. The primary purpose of ED waiting time standards is to measure and monitor the acute hospital’s ability to provide timely access to in-patient beds and sustain patient flow through the ED.
A 6-hour ED time standard is used in New Zealand. A 4-hour total ED time standard was introduced in the UK in 2001. Their current standard is that 95% of patients should be discharged or admitted from EDs within 4 hours and no patient should wait more than 6 hours. Some Australian states have also adopted a 4-hour standard. There is no agreed standard in the US or in Canada, although the same measurement of time waiting is also used.
It is important to acknowledge that the number of patients waiting for admission on trolleys is also a measure of waiting. Trolleys are unfortunately an international phenomenon, occurring in the US, Australia and the UK. They remain an undesirable feature of the Irish Health Services, even though the work of Special Delivery Unit that I established has led to a significant improvement. As of 25 October, the year to date improvement is 12.7%, which translates into 7,146 fewer trolleys reported by the INMO in 2013 when compared to 2012. When compared to 2011, the percentage improvement is 33.6%, equivalent to 24,744 fewer trolleys.
1047. Deputy Billy Kelleher asked the Minister for Health if the criteria used to measure waiting times for surgery is used in any other OECD country; and if he will make a statement on the matter. [45763/13]
View answerThe measurement used in Ireland is the conventional approach to measuring wait times which is also used in Northern Ireland and in the United Kingdom.
1048. Deputy Stephen S. Donnelly asked the Minister for Health if seriously ill patients, or their carer's, are required to reapply for medical cards at six week intervals or at any interval of less than one year; if so the reason for this policy; and if he will make a statement on the matter. [45767/13]
View answerThe HSE has an effective system in place for the provision of emergency medical cards for patients who are terminally ill in palliative care, or who are seriously ill and in urgent need of medical care that they cannot afford. They are issued within twenty-four hours of receipt of the required patient details and the letter of confirmation of the condition from a doctor or a medical consultant. With the exception of terminally ill patients, the HSE issues all emergency cards on the basis that the patient is eligible for a medical card on the basis of means or undue hardship, and that the applicant will follow up with a full application within a number of weeks of receiving the emergency card. As a result, emergency medical cards are issued to a named individual, with a limited eligibility period of six months.
For persons with a terminal illness in palliative care, no means test applies. Once the terminal illness is verified, patients are given an emergency medical card for six months. Given the nature and urgency of the issue, the HSE has appropriate escalation routes to ensure that the person gets the card as quickly as possible.
In any event, renewal assessment forms automatically issue to the holders of all medical card or GP visit cards, three months prior to the expiry date of the card.
1049. Deputy Martin Ferris asked the Minister for Health the reason for the delay in a transfer by ambulance of a seriously ill infant to the Bon Secours Hospital, Cork form Kerry General Hospital on 17 September 2013; and if he will make a statement on the matter. [45770/13]
View answerI am informed by the National Ambulance Service that a private ambulance company carried out this transfer. I have no role in the provision of private ambulance services for patients.
1050. Deputy Tom Fleming asked the Minister for Health if he will expedite surgery in respect of a person (details supplied) in County Kerry; and if he will make a statement on the matter. [45784/13]
View answerThe National Waiting List Management Policy, A standardised approach to managing scheduled care treatment for in-patient, day case and planned procedures, January 2013, has been developed to ensure that all administrative, managerial and clinical staff follow an agreed national minimum standard for the management and administration of waiting lists for scheduled care. This policy, which has been adopted by the HSE, sets out the processes that hospitals are to implement to manage waiting lists.
In relation to this particular query raised by the Deputy, I have asked the Health Service Executive to respond directly to the Deputy in this matter.
1051. Deputy John Lyons asked the Minister for Health if an application for redeployment to another part of the public service will be reconsidered in respect of a person (details supplied) in Dublin 11; and if he will make a statement on the matter. [45827/13]
View answerAs this is a service matter it has been referred to the Health Service Executive for direct reply.
