Written Answers Nos. 23-29
23. Deputy Thomas P. Broughan asked the Minister for Health if he has considered reversing some of the cuts to the dental treatment benefit scheme and the dental treatment services scheme since 2010 in view of reports that considerably fewer adults are visiting their dentists and are putting off dental treatment until it is absolutely necessary. [47944/13]
View answerFunding for the Dental Treatment Services Scheme (DTSS) has been capped at the 2008 level of €63million. There are no immediate plans to reverse the changes to the Scheme in the current budgetary climate. The HSE prioritises for treatment patients with special needs, high risk patients and those who have greater clinical needs and will continue to monitor the operation of the DTSS to ensure the most beneficial, effective and efficient use of available resources.
Responsibility for the Dental Treatment Benefit Scheme rests with my colleague, the Minister for Social Protection.
24. Deputy Clare Daly asked the Minister for Health the reason the Health Service Executive and its national director of quality and patient safety continue to quote the undercounted figures on maternal mortality collected by the Central Statistics Office in order to claim that our figures are among the best internationally, while not using the actual figures on maternal mortality collected by Maternal Death Enquiry Ireland, the officially commissioned body tasked with monitoring these figures accurately. [48054/13]
View answerInternational comparisons of maternal mortality are based on statistics produced by the World Health Organisation (WHO). In calculating the maternal mortality ratio (MMR), the WHO takes account of vital statistics as compiled by national statistical offices (i.e. the Central Statistics Office in the case of Ireland) but also applies a separate weighting to adjust for potential under-reporting. For most developed countries, including Ireland, the weighting factor is 1.5. The most recently published WHO statistics are based on this methodology.
As the Deputy is aware, Ireland recently implemented a Confidential Maternal Death Enquiry (MDE) system using the same model which has been in operation in the United Kingdom (UK) for many years. The first report of the MDE for Ireland was published in 2012 and covered the years 2009 to 2011. Future WHO analysis for Ireland will take account of the MDE results.
Comparison with the UK's most recent MDE shows Ireland with a ratio of 8.6 maternal deaths per 100,000 maternities (2009 to 2011) compared with 11.4 maternal deaths per 100,000 maternities (2006 to 2008) for the UK. It needs to be emphasised that Ireland and the UK are virtually unique in having fully comprehensive MDE reporting systems. The WHO recognises that international rankings of maternal mortality are, therefore, problematic given the difficulty of obtaining accurate estimates of the levels of under-reporting which exist in most countries.
Nevertheless, taking full account of the MDE results, Ireland has amongst the lowest levels of maternal mortality in the developed world and this will continue to be reflected in WHO statistics. Finally, it also needs to be noted that Ireland is a small country and rare occurrences such as maternal mortality will be subject to significant fluctuations in rates where the data are based on a single year or even where data are aggregated over several years. As evidence of this, the 95% confidence limits for the maternal mortality ratio (MMR) in Ireland's MDE covering a three year period (2009 to 2011) range from 4.6 to 12.4 maternal deaths per 100,000 maternities.
25. Deputy Seamus Healy asked the Minister for Health the timescale for the appointment of chairpersons and board members to the new hospital groupings; and if he will make a statement on the matter. [48060/13]
View answerThe Report on the Establishment of Hospital Groups, which I launched on 14 May, is the most fundamental reform of the Irish acute hospital system in decades. The introduction of Hospital Groups will provide for organisational change in the first instance, giving more autonomy and better enabling the reorganisation of services in a well-planned manner. Over time, this will help to improve services and deliver better outcomes for patients.
In July, expressions of interest were invited through the Public Appointments Service for appointment as Chairpersons and members of Hospital Group Boards. Chairs have now been appointed to all seven Hospital Groups. CEOs are in place for three of the Groups, and the process of recruiting CEOs for the remaining four Groups will shortly commence, in consultation with Chairpersons, through the Public Appointments Service. My Department will also enter into discussion with the Chairs with a view to appointing the remaining Board members as soon as possible.
A Strategic Advisory Group is now being established which will oversee the establishment of Hospital Groups and the subsequent reorganisation of acute hospital services. Each group of hospitals will work together as single cohesive entities managed as one, to provide acute care for patients in their area, integrating with community and primary care. This will maximise the amount of care delivered locally, whilst ensuring complex care is safely provided in larger hospitals. Hospital Groups will be required, within one year, to develop a strategic plan which will outline their plans for future services within the group area and the role of hospitals within each group will be considered in detail in the context of this strategic plan.
26. Deputy Mick Wallace asked the Minister for Health in view of the cost of obesity to the State, if he has a strategy for dealing with the issue. [48056/13]
View answerAs Minister for Health, I have made overweight and obesity a public health priority and have established a Special Action Group on Obesity (SAGO) whom I meet with regularly to progress the obesity agenda. The Special Action Group on Obesity comprises representatives from the Departments of Health, Children and Youth Affairs, Education and Skills, the Health Service Executive, the Food Safety Authority of Ireland, Safefood and other key stakeholders, to examine and progress a number of issues to address the problem of obesity. The range of measures being implemented by my Department seeks to promote a healthy lifestyle, to encourage people to make healthier food choices, to become more active and take the first steps towards reducing obesity.
The Special Action Group on Obesity is concentrating on a range of measures including actions such as: calorie on menus in restaurants, how best to support healthy eating choices, the supply of healthy food products in vending machines, the detection and treatment of obesity, healthy eating guidelines and the promotion of physical activity. As one of the measures specifically designed to combat Childhood Obesity, on Monday 21st October, I launched the Safefood/Healthy Ireland/HSE three year Childhood Obesity Campaign – Childhood Obesity: Let's take it on – one small step at a time which is designed to create greater awareness among parent's about the threat of childhood overweight and obesity and provide practical tips to help address the problem with the ultimate aim and effecting behaviour change.
I also tasked SAGO with establishing a sub-committee to investigate and develop a range of options around pricing and other mechanisms in order to reduce consumption of foods and drinks from the top-shelf of the Food Pyramid (as per the Department of Health's Healthy Eating Guidelines) as these foods and drinks are not necessary for health. The sub-committee's report and recommendations were presented to me on Wednesday, 23rd October when I attended a meeting of SAGO and an action plan is now being developed around these recommendations.
Because the issue of Childhood Obesity is of such serious concern for me I placed it centre stage of the Irish Presidency of the EU and was successful in having the EU mandated to draw up an EU Action Plan to tackle Childhood Obesity. This Plan has been drafted and will be finalised before the end of the year. SAGO will continue to liaise with other Departments and organisations in a cross-sectoral approach to further progress initiatives to help halt the rise in overweight and obesity.
27. Deputy Billy Kelleher asked the Minister for Health the reason the programme for Government commitment to an annual ring-fenced allocation of €35 million for community health services is not being honoured in 2014; and if he will make a statement on the matter. [48049/13]
View answerMental health has again succeeded in obtaining a substantial ring-fenced allocation, within the overall budgetary context. The current economic environment presents a significant challenge for the health system generally in delivering services, however, mental health is being treated as a priority in so far as we can.
The announcement in Budget 2014 of €20 million ringfenced for mental health is in line with a commitment in the Programme for Government to accelerate the pace of change to develop a modern, patient-centred, and recovery orientated mental health service. This further ringfenced funding for mental health means that, despite serious resource pressures overall, funding of €90 million has been made available since 2012 up to end 2014, which has been specifically ear-marked for mental health and suicide prevention.
I can confirm to the Deputy that I have been assured that the remaining €15 million which was due in 2014 for mental health will be restored in 2015. I will also be advocating for an allocation of €35 million in 2015 for mental health.
28. Deputy Caoimhghín Ó Caoláin asked the Minister for Health the reason, despite the recent introduction of generic substitution and reference pricing, the Health Service Executive is still paying up to four times as much as the NHS for some of the most commonly prescribed medicines; and if he will make a statement on the matter. [48066/13]
View answer29. Deputy Peter Mathews asked the Minister for Health if he is satisfied that the price paid for drugs by the Health Service Executive is comparable with those paid by national health services in other OECD countries; and if he will make a statement on the matter. [42415/13]
View answerI propose to take Questions Nos. 28 and 29 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. The State has introduced a series of reforms in recent years to reduce pharmaceutical prices and expenditure. These have resulted in reductions in the price of thousands of medicines. Price reductions of the order of 30% per item reimbursed have been achieved between 2009 and 2013; the average cost per items reimbursed is now running at 2001/2002 levels.
A major new deal on the cost of drugs in the State was concluded with the Irish Pharmaceutical Healthcare Association (IPHA) in October 2012. 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 IPHA agreement provides that prices are referenced to the currency adjusted average price to wholesaler in the nine EU member states. The price of a range of medicines were reduced on 1 January 2013 in accordance with the agreement. The gross savings arising from this deal will be in excess of €400 million over 3 years. €210 million from the gross savings will be available to fund new drugs.
A new agreement was also reached with the Association of Pharmaceutical Manufacturers in Ireland (APMI), which represents the generic drugs industry. Since 1 November 2012, the HSE only reimburses generic products which are priced at 50% or less of the initial price of an originator medicine. This represents a significant structural change in generic drug pricing and should lead to an increase in the generic prescribing rate. It is estimated that the combined gross savings from the IPHA and APMI deals will be in excess of €120 million in 2013 with an additional €28 million saved in 2014.
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. It is estimated that this system will yield €50 million in savings in 2014. 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. Once the IMB has assessed the initial 20 priority products, then 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 provides that the HSE may set a reference price for groups of interchangeable products published on the List of Interchangeable Products with a view to introducing further significant price cuts. Taking both price reductions into account, atorvastatin prices are down 70% since the introduction of generic substitution.
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. The first reference price for atorvastatin products was implemented on 1 November 2013. Reference prices will ensure that generic prices in Ireland will fall towards European norms.
