Written Answers Nos. 322-334
322. Deputy Terence Flanagan asked the Minister for Health the reason medication costs three to five times more here than in other European countries; his plan to reduce costs, and not just for generic drugs; and if he will make a statement on the matter. [2009/14]
View answerThe 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 prices 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 €148 million 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 Medicinal Products, containing groups of atorvastatin products, was published by the IMB on the 7th August 2013. The IMB is updating the List of Interchangeable Medicinal Products on an ongoing basis and it expects to complete the assessment of the top 20 priority medicines by end Quarter 1 2014. A further list of 20 priority groups of products will then be identified and it is anticipated that the assessment of this list will be completed by the IMB by Quarter 4 2014. The process will then continue until all relevant medicinal products on the reimbursable list have been assessed.
Once a List of Interchangeable Medicinal Products 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 Medicinal 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. The reference price for esomeprazole 20mg products was implemented on 1 January 2014 and it is expected that reference prices for esomaprazole 40mg and rosuvastatin products will be implemented on 1 February 2014. The HSE will continue to implement reference prices for the remaining groups of interchangeable products published by the IMB on an on-going basis throughout 2014. It is expected that 80% of the off-patent market by value will be reference priced by end 2014. Reference prices will ensure that generic prices in Ireland will fall towards European norms.
323. Deputy Terence Flanagan asked the Minister for Health the action being taken to deal with patients on trolleys in hospitals; his views on the number of patients on trolleys in Beaumont Hospital over the past month; and if he will make a statement on the matter. [2010/14]
View answerAs this is a service matter, I have asked the HSE to respond directly to the Deputy.
324. Deputy Terence Flanagan asked the Minister for Health the role and responsibilities of the CEO of the Health Service Executive; if he will outline his targets and details of his performance package; if a bonus is payable; and if he will make a statement on the matter. [2011/14]
View answerUnder current legislative arrangements the HSE does not have a Chief Executive Officer. The Health Service Governance Act 2013 replaced the HSE Board and CEO structure with a Directorate structure. The Directorate is comprised of the Director General and a number of appointed Directors and is the governing body of the HSE. The Directorate is accountable to the Minister for the performance of its functions and those of the Executive and the Director General shall account to the Minister, through the Secretary General, on behalf of the Directorate for the performance by the Directorate of its functions and those of the Executive.
In addition to his functions as a member of the Directorate and as the chairperson of the Directorate, the Director General carries on, manages and controls generally the administration and business of the Executive.
The approved salary for this post is €183,350 per annum. The Director General does not receive a bonus or any other performance related remuneration under the terms of his contract.
325. Deputy Terence Flanagan asked the Minister for Health the role and responsibilities of the CEO of the Department of Health; if he will outline his targets and provide details of his performance package; if a bonus is payable; and if he will make a statement on the matter. [2012/14]
View answerThe Administrative Head of the Department of Health is the Secretary General. The salary for this position is €176,350 per annum and there are no bonus payments.
The role of the Department of Health is to provide strategic leadership for the health service and to ensure that Government policies for the sector are translated into actions and implemented effectively. The overall purpose of the health service is to improve the health and well-being of people in Ireland by keeping people healthy, providing the healthcare people need, delivering high quality services and getting best value from the health system resources. The Programme for Government sets out an ambitious reform agenda which aims to improve the health system's ability to achieve this core purpose.
As head of the Department the role of the Secretary General, who was appointed following an open Top Level Appointments Committee (TLAC) recruitment and selection process, is to provide:
- advice and support to the Minister, the Ministers of State and the Government on all matters of policy and regulation in relation to health;
- effective management and leadership of the Department of Health, both in its own direct work and in its leadership role for the overall health sector;
- strategic leadership as a member of the overall system of public administration.
326. Deputy Terence Flanagan asked the Minister for Health the innovative measures he has introduced to the health service since his appointment; his future plans regarding innovation; and if he will make a statement on the matter. [2013/14]
View answerI understand that officials from my Department have clarified the scope of the question with the Deputy and a comprehensive answer will issue directly to the Deputy in the near future.
327. Deputy Terence Flanagan asked the Minister for Health the steps he has taken to date to recover top-up moneys from taxpayers paid to CEOs of Irish hospitals; and if he will make a statement on the matter. [2019/14]
View answerAs was outlined in the HSE's Internal Audit Report, a considerable number of Section 38 agencies were found to be in breach of Government pay policy with regard to the remuneration of senior staff.
The HSE has a team of senior managers following up with individual agencies and the Director General of the HSE met with the Chairpersons and the CEOs of all the Section 38 organisations in December 2013. Further and separate meetings were held by senior HSE managers with all of the disability organisations and hospitals concerned to ensure that a clear plan to achieve full compliance with health sector pay policy is developed with each agency.
I understand that a number of agencies have submitted business cases in relation to these payments and these will be closely examined by the HSE. As set out in the Department’s pay policy, if an organisation wishes to make a business case for the continuation of an unapproved allowance, it is open to it to do so and any such cases will be considered by the HSE (with the involvement of the Department of Health and the Department of Public Expenditure and Reform, as necessary).
As indicated above the HSE is urgently meeting individual agencies and it is important that due process is followed.
328. Deputy Terence Flanagan asked the Minister for Health the investigation his Department has carried out in respect of a clinic (details supplied); and if he will make a statement on the matter. [2020/14]
View answerThe issue raised by the Deputy is a service issue and I have therefore referred the matter to the Executive, for attention and direct reply.
329. Deputy Terence Flanagan asked the Minister for Health the effect the implementation of the working time directive will have on hospitals; the fines that will be applied; and if he will make a statement on the matter. [2022/14]
View answerFull implementation of the European Working Time Directive will have beneficial effects, for the doctors concerned, patients in their care and hospitals. The achievement of compliance with the provisions of the Directive in respect of non-consultant hospital doctors by end 2014 is a priority of the Government, in order to improve patient safety as well as the working conditions of doctors. It will also support the efficient delivery of care within hospitals.
The development of robust plans to achieve compliance in each hospital and their implementation are priorities for health sector management in 2014. Under a set of proposals agreed under the auspices of the Labour Relations Commission in October 2013, the Irish Medical Organisation is now jointly involved with health service national management in an ongoing process to assess the position in each hospital site and agree focused and timebound requirements to resolve outstanding issues.
Failure to achieve compliance with the provisions of a Directive can result in significant financial penalties, including periodic penalties and lump sum payments, reflecting the seriousness of the infringement, the duration of the infringement and the Member State's ability to pay. While it is possible that fines may arise if compliance with the Directive is not achieved, the intention is that it will be achieved and in a timeframe that would rule out such fines.
It is recognised that achieving full compliance by end 2014 is a significant challenge and may require changes to service configuration in some instances. However, it must be achieved. The establishment of Hospital Groups and implementation of the principles set out in the Small Hospitals Framework will assist in this regard.
330. Deputy Terence Flanagan asked the Minister for Health the moneys paid to the Rehab group over the past five years; the salary of the CEO of the Rehab group; and if he will make a statement on the matter. [2024/14]
View answerThe REHAB Group receives funding from the Health Service Executive under Section 39 of the Health Act 2004. The Department has asked the HSE to provide the Deputy with the funding provided to the REHAB Group from 2008 to 2012.
Staff in organisations funded under Section 39 of the Health Act 2004, including the REHAB Group, are not classified as public servants. They are not counted in public service numbers, don’t have public service pensions and are not bound by the Department of Health Consolidated Salary Scales.
At the request of the Minister for Health, the HSE has written to all CEOs of Section 39 agencies, including the REHAB Group, outlining health sector pay policy and requesting each agency to have due regard to public pay policy, in particular in respect of each agency’s senior management.
The Government is concerned to ensure that the State receives value for all monies invested in public services on behalf of the taxpayer. It is also important that all agencies in receipt of public funds would have due regard for overall Government pay policy.
331. Deputy Terence Flanagan asked the Minister for Health if there are any health effects of pylons located close to residents' homes; and if he will make a statement on the matter. [2029/14]
View answer340. Deputy Caoimhghín Ó Caoláin asked the Minister for Health his concerns regarding the health effects of power cables, as cited in his letters to the Departments of Communications, Energy and Natural Resources and Environment, Community and Local Government in March 2012; and if he will make a statement on the matter. [2121/14]
View answerI propose to take Questions Nos. 331 and 340 together.
The Department of the Environment, Community and Local Government has responsibility for potential health effects of Electromagnetic Fields (EMF). Ireland has taken a precautionary approach on this issue and adopted international guidelines for exposure to electromagnetic radiation developed by the International Commission on Non-Ionizing Radiation Protection (ICNIRP).
National and international health and scientific agencies have reviewed more than 30 years of research into electromagnetic fields (EMF). None of these agencies has concluded that exposure to EMF from power lines or other electrical source is a cause of any long-term adverse effects on human, plant or animal health.
The issue of the potential health effects of electromagnetic fields was the subject of an Expert Group Report commissioned by the Government and published in March 2007. The Expert Group reported that the majority scientific opinion was that no adverse short- or long-term effects have been demonstrated from exposure to electromagnetic fields at levels below the limits recommended by the ICNIRP.
A substantial volume of research on this issue is being carried out internationally by regulatory bodies with responsibilities for monitoring the health effects of electromagnetic fields. The findings of this research are being monitored by the World Health Organisation’s (WHO) EMF Project; it is expected that a report will issue in 2014. The Department of the Environment, Community and Local Government is continuing to monitor this and other scientific evidence as it is made available, and will consider any policy implications in this context.
I am advised on all matters relating to public health on an on-going basis by the Chief Medical Officer, Dr Tony Holohan. The CMO and his staff keep abreast of relevant national and international policy matters, research and data that have relevance to public health. The CMO has advised me that on the basis of international evidence, health considerations relating to electricity pylons do not warrant my involvement.
332. Deputy Terence Flanagan asked the Minister for Health if he will provide a full breakdown of the set up costs of the Health Service Executive; and if he will make a statement on the matter. [2035/14]
View answerThe establishment of the HSE involved the consolidation of the existing health boards and Comhairle na nOispideal, and as such did not generate set up costs. The existing funding for the health boards and hospitals, funded through the Vote of the Department of Health, was the basis for the funding of the HSE.
However, in the Revised Estimates 2005 certain once-off technical adjustments had to be made due to the establishment of the HSE as a Vote holder. In the past the total expenditure of Health Boards and some other Health Agencies was not recouped in full in the year of account. This required availing of approved bank overdraft facilities until a payment in respect of balances due was made in the following year. The creation of a separate Vote for the HSE and the requirement not to have recourse to overdraft facilities necessitates a higher level of recoupment through the Vote. This resulted in an additional allocation in 2005, on a once-off basis. There was a further once-off additional requirement arising from the change in the accounting treatment of statutory and other deductions from employee salaries. The total amount involved was of the order of €217m. Due to the fact that these are technical adjustments only, and notwithstanding the increased requirement for 2005, these two upward adjustments did not give rise to a higher level of expenditure to be borne by the taxpayer.
333. Deputy Éamon Ó Cuív asked the Minister for Health the provision for the fair deal scheme in the Estimates of 2012, 2013 and 2014; the outturn for 2012; the number of places on the fair deal scheme that will be reduced in 2014; the number of applications being assessed and the average time to assess an application; the length of the waiting list of approved applicants currently awaiting fair deal payment to commence; the average length of time waiting from approval to commencement of payment; and if he will make a statement on the matter. [2063/14]
View answerThe needs of our older people are, and will remain, a very high priority for me and for the Government, and the resources that are available will be applied to provide the best possible mix of supports and services in a way that most effectively matches the needs and preferences of older people themselves, with a particular focus on enabling people to live as independently as possible in the community.
The total budget for long-term residential care was €994.7m in 2012, €974m in 2013 and is €939m for 2014. According to the Appropriation Accounts published on the Comptroller and Auditor General's website, the expenditure outturn in 2012 was €962.6m. The outturn for 2013 is not yet available.
The €939m available for the Nursing Homes Support Scheme in 2014 represents a reduction of €35m on the 2013 provision. The target in the HSE's National Service Plan 2013 was for 22,761 persons to be in receipt of financial support for long-term nursing home care by year end. The target in the National Service Plan 2014 is 22,061 recipients.
However, the National Service Plan 2014 indicates that €23m is being transferred from the Nursing Homes Support Scheme to provide additional community services, with a view to allowing more older people to be supported in their own homes and communities for longer. This reorientation is in line with both Government policy and with the expressed wishes of older people.
At end October 2013 there were 1,434 applications for the Scheme in the process of being determined. At that time, each application was taking almost 4-6 weeks to process.
On the 10th January there were 512 people on the placement list (i.e. approved for the Scheme but awaiting the release of funding) for the Scheme. At that stage it was taking about 4 weeks for funding to issue, from the date that the person was first placed on the list.
334. Deputy Róisín Shortall asked the Minister for Health the reason the cost of operating a car for persons with mobility limiting disabilities is not included as part of the medical card means assessment in the same manner as travel to work costs; if such costs can be considered medical expenses in cases where a person is completely dependent on their vehicle; and if he will make a statement on the matter. [2070/14]
View answerUnder the provisions of the Health Act 1970 (as amended), a person has full eligibility for health services, specifically a medical card, where he/she is unable without undue hardship to arrange general practitioner medical and surgical services for him/herself and dependents. The assessment for a medical card is determined primarily by reference to the person's overall financial situation, including the means and expenditure, of the applicant and his or her partner and dependants.
The assessment of eligibility is based on the combined income of the applicant and spouse or partner (if any) after tax, PRSI and USC have been deducted. The income guidelines include basic weekly allowances having regard to the applicant’s age, status and number of dependants.
Additional allowances, as detailed in the HSE Medical Card/G.P. Visit Card National Assessment Guidelines, are available for necessary expenses incurred in respect of travel to work costs. Where public transport is not available or suitable and a car is required, reasonable travel costs will be allowed as set out hereunder:
- 18c per km/30c per mile to cover running costs
- car pooling arrangements and any contribution towards costs should be taken into account
- in the case of a couple where they require two cars to travel to work and meet the above requirements, both sets of trips will be taken into account
- the rate per km/mile does not contain any element towards parking costs and where, they are an issue, they should be included on an actual cost basis.
Any application with details of travel to work costs will be assessed against the guidelines outlined above.
