Tuesday, 4 Feb 2014

Written Answers Nos. 631-53

Tobacco Control Measures

Questions (631)

Jerry Buttimer

Question:

631. Deputy Jerry Buttimer asked the Minister for Health his plans to regulate the sale and supply of e-cigarettes; and if he will make a statement on the matter. [4958/14]

Written answers

Minister for Health

I wish to inform the Deputy that I intend to regulate the e-cigarette market. In Ireland the current position is that if these products are not presented as medicinal products for smoking cessation or as medical devices with a therapeutic purpose, they do not fall under the medicinal products or medical devices legislation. As e-cigarettes do not contain tobacco they are currently not regulated under our tobacco legislation.

In order to harmonise the way EU Member States regulate e-cigarettes, the new Tobacco Products Directive being developed by the European Commission will, inter alia, provide for the regulation of e-cigarettes. It is anticipated that the Directive will be adopted formally by Council later this year following a vote in the European Parliament. Member States will have two years to transpose the Directive.

The Tobacco Directive will set mandatory safety and quality requirements e.g. nicotine content, ingredients and devices, as well as refill mechanisms etc. for e-cigarettes that do not fall under the definition of medicinal products of Directive 2001/83/EC. The new Directive will make health warnings and information leaflets obligatory, introduce notification requirements for manufacturers and importers of e-cigarettes, impose stricter rules on advertising and monitoring of market developments. The Directive will also enable Member States and the European Commission to react in the case of any identified health concerns related to these products.

Tobacco Free Ireland, Ireland’s tobacco control policy, states that the general consensus at European level is that there is a lack of research in relation to the long term health effects of e-cigarettes and a lack of sufficient evidence that they aid with smoking cessation. In light of the above and in view of the emerging evidence base around e-cigarettes, I have asked my Department to review the evidence on the potential harm and the potential benefits of e-cigarettes before deciding the best approach to their wider regulation.

Hospital Appointment Status

Questions (632)

Dan Neville

Question:

632. Deputy Dan Neville asked the Minister for Health the position regarding a hospital appointment in respect of a person (details supplied) in County Limerick; and if he will make a statement on the matter. [4967/14]

Written answers

Minister for Health

A maximum waiting time target of 12 months has been set for a first time consultant-led outpatient appointment and this is reflected in the HSE Service Plan. The SDU and the NTPF are working closely with hospitals towards achievement of the maximum waiting time. Should a patient's general practitioner consider that the patient's condition warrants an earlier appointment, he or she would be in the best position to take the matter up with the consultant and hospital involved. In relation to the specific hospital appointment query raised by the Deputy, as this is a service matter it has been referred to the HSE for direct reply.

Hospital Services

Questions (633)

Michael Lowry

Question:

633. Deputy Michael Lowry asked the Minister for Health if all blood samples taken in the mid-west region are sent to the Mid-Western Regional Hospital in Limerick for testing; his views on whether that office is adequately staffed to deal with this increased volume of blood samples; if he will sanction further staff to assist that office; if he will confirm the percentage of the submitted samples that are tested within the required timeframe; if he will confirm what becomes of untested samples after this date; if his attention has been drawn to the hardship and distress this causes to patients; and if he will make a statement on the matter. [4972/14]

Written answers

Minister for Health

In relation to the detailed query raised by the Deputy, as these are service matters, I have asked the Health Service Executive to respond to him directly.

Appointments to State Boards

Questions (634, 635)

Catherine Murphy

Question:

634. Deputy Catherine Murphy asked the Minister for Health if he will itemise in tabular form the occasions on which his Department has engaged the services of external professional advice such as a company (details supplied) on the appointment of persons to State boards; if he will list the fees paid in respect of such services; the persons who were ultimately appointed on foot of advice received; and if he will make a statement on the matter. [4989/14]

Catherine Murphy

Question:

635. Deputy Catherine Murphy asked the Minister for Health if he will identify any instances where a person appointed to a State board after recruitment advice was received from professional external consultants was subsequently deemed to be unqualified for the duties and responsibilities attached to the role; the costs incurred in obtaining advice in respect of each such instance; and if he will make a statement on the matter. [5005/14]

Written answers

Minister for Health

I propose to take Questions Nos. 634 and 635 together.

My Department has not engaged the services of external professionals when making appointments to State Boards and therefore no fees in respect of such services have been paid.

Health Services Staff Recruitment

Questions (636)

Finian McGrath

Question:

636. Deputy Finian McGrath asked the Minister for Health the position regarding a level 5 FETAC course in respect of a person (details supplied) in Dublin 5; and if he will make a statement on the matter. [5059/14]

Written answers

Minister for Health

I have been advised by the HSE that the person concerned is not an employee of the Executive and is in fact an employee of Raheny Home Help, a voluntary organisation. In these circumstances the issue raised by the Deputy, the need for the level five qualification, is a 'conditions of employment' matter between Raheny Home Help and the person concerned.

Health Services Staff Recruitment

Questions (637)

Finian McGrath

Question:

637. Deputy Finian McGrath asked the Minister for Health the reason there are no doctors in the psychiatric unit at the Killester clinic, Dublin 5. [5060/14]

Written answers

Minister of State at the Department of Health

As this is a service issue this question has been referred to the HSE for direct reply.

Health Services Provision

Questions (638)

Seán Fleming

Question:

638. Deputy Sean Fleming asked the Minister for Health when a sustainable long-term solution will be provided in respect of a person (details supplied) in County Laois; and if he will make a statement on the matter. [5083/14]

Written answers

Minister of State at the Department of Health

As 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.

Hospital Equipment

Questions (639)

Brian Walsh

Question:

639. Deputy Brian Walsh asked the Minister for Health the current location of an extracorporeal shock wave lithotripsy machine purchased for University Hospital Galway in 2010; and the number of public patients who have been treated using this machine each year since its purchase. [5096/14]

Written answers

Minister for Health

In relation to the detailed information requested by the Deputy, as these are service matters, I have asked the Health Service Executive to respond to him directly.

Air Pollution

Questions (640)

Clare Daly

Question:

640. Deputy Clare Daly asked the Minister for Health the reason he has refused to investigate a public report, put before him by the Irish Environmental Forum, which was published by Professor Jacqueline McGlade of the European Environmental Agency entitled, The Cost of Air Pollution. [5100/14]

Written answers

Minister for Health

The matter to which the Deputy refers relates to air quality and I do not have a function in relation to this matter.

Health Services

Questions (641)

Stephen Donnelly

Question:

641. Deputy Stephen S. Donnelly asked the Minister for Health the analysis and data used by his Department, in consideration of whether the Health Service Executive should take over Mount Carmel Hospital, which led to the determination that Mount Carmel would not be of value to the health system; and if he will make a statement on the matter. [5105/14]

Written answers

Minister for Health

Following approaches from NAMA, my Department examined the possibility of acquiring Mount Carmel Hospital as a going concern. However, it was clear from the outset that the purchase of Mount Carmel as a stand-alone maternity hospital, or as a maternity unit in a non-acute setting, would not be in line with current Government policy. Government policy on maternity services is based on the premise that for optimal clinical outcomes, maternity services should be co-located with adult acute services, or in the case of neonatology and foetal medicine, tri-located with adult and paediatric services. The low volume of births in the hospital was also an issue, as best practise and the development of excellence in patient care and safety is predicated on high volume of patient throughput, in accordance with international norms.

In addition, as my Department is currently developing a new National Maternity Strategy, I believe that it would be premature at this stage, in advance of considerations regarding the future models of maternity service provision, to make any decisions in relation to securing additional maternity service capacity in any part of the country.

In terms of the capacity of the HSE to deal with the additional service demands on the closure of the hospital, the Deputy may wish to note that birth rates have fallen significantly in recent years and the CSO projects that birth rates will continue to fall at least until the early 2020s. In the longer term, the move of the National Maternity Hospital from Holles Street to the St Vincent’s campus together with the development of the new maternity hospital tri-located on the St James’s campus, will afford us the opportunity to provide additional maternity services capacity, if required.

Health Services Staff

Questions (642)

Stephen Donnelly

Question:

642. Deputy Stephen S. Donnelly asked the Minister for Health the plans that have been developed in his Department to date for bringing any and all of the highly skilled workforce from Mount Carmel Hospital into the public health workforce, as intimated by him when he said we will certainly be looking at every possibility and way of bringing them into the public sector if we can; and if he will make a statement on the matter. [5106/14]

Written answers

Minister for Health

Given the need to meet fiscal and budgetary targets the numbers employed in the public service must be reduced. The health sector must make its contribution to that reduction. However, the HSE can make staff appointments to critical front line posts where it is necessary to do so to support essential service delivery. Frontline vacancies that could be suitable for many of the Mount Carmel staff, including consultant, nursing and midwifery posts continue to be filled by the HSE. I would hope that it will be possible for many of the staff who provided care in Mount Carmel to obtain posts within the public system in the coming months.

Treatment Abroad Scheme

Questions (643, 683, 684)

Thomas P. Broughan

Question:

643. Deputy Thomas P. Broughan asked the Minister for Health further to Parliamentary Question No. 697 of 19 November 2013, if the report which he undertook to obtain from the Health Service Executive in relation to the applications to the treatment abroad scheme from person's affected by Ehlers-Danlos syndrome is now to hand. [5120/14]

Micheál Martin

Question:

683. Deputy Micheál Martin asked the Minister for Health if his Department or the Health Service Executive has a policy to allow children with EDS syndrome to seek treatment abroad; and if he will make a statement on the matter. [5417/14]

Micheál Martin

Question:

684. Deputy Micheál Martin asked the Minister for Health the number of applications received by the health services in 2012 and 2013 for children with EDS syndrome to be treated abroad; and if he will make a statement on the matter. [5418/14]

Written answers

Minister of State at the Department of Health

I propose to take Questions Nos. 643, 683 and 684 together.

The HSE records information relating to the Treatment Abroad Scheme based on the treatment for which the patient is being referred outside the state and not on the basis of an identified condition. In compliance with the HSE's guidance on patient confidentiality and data protection, the release of statistical information is based on a volume of cases of five or greater. On this basis, we cannot provide the information requested by the Deputy.

The HSE operates a Treatment Abroad Scheme (TAS), for persons entitled to treatment in another EU/EEA member state or Switzerland under EU Regulation 1408/71, as per the procedures set out in EU Regulations 574/72, and in accordance with Department of Health Guidelines. Within these governing EU Regulations and the Department of Health Guidelines, the TAS provides for the cost of approved treatments in another EU/EEA member state or Switzerland through the issue of Form E112 (IE). A decision is made on each application in accordance with this legislation and guidelines and on the basis of a review by clinical experts. The cost of the treatment is not a deciding factor when approving an application. The treatment must not be available within the State or not available within a time normally necessary for obtaining it.

The TAS allows for an Irish based medical consultant to refer a patient that is normally resident in Ireland for treatment, in a public hospital, in another EU/EEA member state or Switzerland, where the treatment in question meets the following criteria:

(a) The application to refer a patient abroad has been assessed and a determination given before that patient goes abroad.

(b) Following clinical assessment, the referring Consultant certifies the following:

- They recommend the patient be treated in another EU/EEA country or Switzerland;

- The treatment is medically necessary and will meet the patient’s needs;

- The treatment is a proven form of medical treatment and is not experimental or test treatment;

- The treatment is in a recognised hospital or other institution and is under the control of a registered medical practitioner;

- The hospital outside the state will accept EU/EEA form E112 (IE).

and wish to confirm that applications for the Treatment Abroad Scheme are assessed on a case by case basis.

As stated above, the HSE TAS processes applications on the basis of the treatment that the patient is being referred outside the state to receive, which is not available in Ireland. The presence of a rare illness, such as Ehlers Danlos Syndrome, is not of itself criteria for availing of treatment abroad: most rare diseases are treated without the need for recourse to services in other jurisdictions.

Patients, in conjunction with their Irish based public referring hospital consultant, have the ability to apply to the HSE TAS seeking access to public healthcare outside the state through model form E112. Applications to TAS are processed and a determination given in accordance with the statutory framework prior to a patient travelling to avail of treatment. Approved applicants/patients' hospital treatment costs are covered through the issue of form E112 (IE) for the specific identified episode of care. Once a patient is discharged from a specific episode of care abroad, their care immediately reverts to their Irish based consultant.

Each application to the HSE TAS is reviewed individually on its own merits and there are no restrictions, regarding age or otherwise, on a person making an application to the HSE TAS for review and decision. Previous approvals or declines are not used as an influencing factor on subsequent applications. Each application is for an individual episode of care unless otherwise specified by the consultant on the application form. Each application to TAS is processed and given a formal written decision. If that decision is one of decline, the reason for that decision is clearly outlined and the option of an appeal is afforded. Furthermore, as above the decision on an application does not restrict future applications for an individual patient or indeed other patients seeking treatment abroad that is not available in Ireland.

It is not possible to give a "blanket" statement on application s to TAS for patients with a particular condition, not least in relation to EDS where its presentation differs from patient to patient. As outlined above, applications are made in respect of a specified treatment not available in Ireland.

Health Services Provision

Questions (644)

John McGuinness

Question:

644. Deputy John McGuinness asked the Minister for Health if he will outline the current and long-term care plan in respect of a person (details supplied) in County Carlow; and if he will make a statement on the matter. [5163/14]

Written answers

Minister of State at the Department of Health

As this is a service issue this question has been referred to the HSE for direct reply.

School Guidance Counsellors

Questions (645)

John McGuinness

Question:

645. Deputy John McGuinness asked the Minister for Health if a comprehensive response will be issued to correspondence sent to him on 8 October 2013 from a person (details supplied) regarding guidance counselling in schools and the issue of suicide. [5166/14]

Written answers

Minister of State at the Department of Health

The Office of the Minister for Health has no record of receiving the correspondence referred to by the Deputy.

Disability Support Services

Questions (646)

Seán Kenny

Question:

646. Deputy Seán Kenny asked the Minister for Health the number of vacancies in each early intervention team in Dublin North-East; the length of time each post has been vacant; if he will ensure all posts are filled as soon as possible; and if he will make a statement on the matter. [5179/14]

Written answers

Minister for Health

The Health Service Executive has recognised the need to increase the level of consistency and standardisation in the way both early intervention services and services for school-aged children with disabilities, including autism, are delivered. It is currently engaged in a reconfiguration of existing therapy resources to geographically based Early Intervention and School-Age Teams under its national Progressing Disability Services for Children and Young People (0-18 years) Programme. The staffing of these Teams and the filling of vacant posts are service matters for the Health Service Executive. Accordingly, my Department has asked the HSE to provide the Deputy with the detailed information requested concerning Early Intervention Teams in Dublin North East.

Hospital Consultants Recruitment

Questions (647)

Seán Kenny

Question:

647. Deputy Seán Kenny asked the Minister for Health his plans to appoint a full-time consultant paediatrician urologist at Temple Street Children's Hospital, Dublin 1; and if he will make a statement on the matter. [5180/14]

Written answers

Minister for Health

In relation to the particular query raised by the Deputy, as this is a service matter, I have asked the Health Service Executive to respond to him directly.

Medical Card Eligibility

Questions (648)

Seán Ó Fearghaíl

Question:

648. Deputy Seán Ó Fearghaíl asked the Minister for Health if he will restore a full medical card to a person (details supplied) in County Kildare with a long-term illness, who have had their card removed after nine years; and if he will make a statement on the matter. [5189/14]

Written answers

Minister of State at the Department of Health

The 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.

Medical Card Applications

Questions (649)

Bernard Durkan

Question:

649. Deputy Bernard J. Durkan asked the Minister for Health if, and when, a medical card will issue in the case of a person (details supplied) in County Kildare; and if he will make a statement on the matter. [5190/14]

Written answers

Hospital Appointment Delays

Questions (650)

Bernard Durkan

Question:

650. Deputy Bernard J. Durkan asked the Minister for Health if, and when, an appointment will be arranged with an ear specialist in respect of a person (details supplied) in County Kildare; and if he will make a statement on the matter. [5217/14]

Written answers

Minister for Health

In relation to the particular patient query raised by the Deputy, as this is a service matter, I have asked the Health Service Executive to respond to him directly.

Services for People with Disabilities

Questions (651)

Jerry Buttimer

Question:

651. Deputy Jerry Buttimer asked the Minister for Health the progress being made towards affording access to individualised funding for persons with a disability; and if he will make a statement on the matter. [5222/14]

Written answers

Minister of State at the Department of Health

The move towards a model of funding which is linked to individual need is encompassed by the recommendations in the Value for Money (VFM) and Policy Review of Disability Services in Ireland. The Department of Health and the Health Service Executive (HSE) will pursue the issue of individualised budgeting in the context of the implementation of the recommendations contained in the VFM Review.

Individualised budgeting is an umbrella term that may take many forms, ranging from a method of determining resource allocation to agencies based on assessed client need and actual costs, to a ‘money follows the client’ model, a brokerage system or a personal budget model administered by the individual service user. The essence of individualised budgeting is that the individual is given more choice and control over how the money allocated to meet their needs is utilised. This might or might not involve the transfer of actual funds to the individual. This approach must be underpinned by a standardised needs assessment to ensure fairness and transparency in the way in which funding is allocated. The move towards an individualised budgeting framework raises legal and practical issues, and will require careful consideration and possibly legislation.

The priority is to further improve current services, while expediting the analysis of the benefits to be gained from newer models of individualised supports through demonstration projects which will be evaluated for wider applicability. The balance and emphasis will shift firmly and comprehensively towards these new models of individualised supports once sufficient analysis of the benefits is carried out in the Irish context and adequate financial management, resource allocation and governance structures are in place to ensure their long-term viability.

Demonstration projects are already underway to examine the practical aspects of introducing this major change and to establish the costs and benefits. An analysis of the projects will commence towards the end of 2014 to determine their wider applicability, clarify the issues which must be resolved before the projects can be scaled up, and identify the best way forward. Work is also underway to identify a standardised national assessment tool and resource allocation model which will form the basis of the individualised budgeting framework. Other essential elements of the new model of service delivery and funding, such as a commissioning strategy and an outcome measurement framework, are also in development.

Medical Card Eligibility

Questions (652)

Dara Calleary

Question:

652. Deputy Dara Calleary asked the Minister for Health the rationale behind persons living in the State but working in Northern Ireland, part of the UK, holding full Irish medical cards; if the Irish Government is compensated by the Government of Northern Ireland for this cost; and if he will make a statement on the matter. [5231/14]

Written answers

Minister of State at the Department of Health

EU Regulation 883/2004 provides for, and supports, the free movement of people within Member States. This Regulation is binding on all Member States and must be implemented as directed. It does not allow for any discretionary element in establishing entitlement. It is the link with the social security system of a Member State which makes any particular Member State liable for a persons's healthcare costs in the country where he/she is residing. Frontier workers, i.e. persons who live in one Member State but pay social security contributions in another, are also entitled to receive their healthcare both in their State of residence and in the State where they are employed and paying social insurance contributions. In this regard, a person resident in Ireland who is working in Northern Ireland and paying their contributions there, would normally be entitled to receive healthcare services in Ireland at the cost of the UK, provided they are not subject to Irish social security legislation. Persons in this category are entitled to full eligibility and receive a medical card on the basis of EU Regulations as evidence of their entitlement.

The EU Regulations allow for two or more States to agree alternative arrangements for reimbursement other than those laid down in the Regulations, or to mutually waive reimbursement altogether. The reimbursement arrangements under the Ireland/UK bilateral agreement cover such persons as temporary visitors between the two countries, pensioners of one country and their dependants residing in the other country, and the dependant family members, residing in one country, of persons employed and residing in the other country. Costs in relation to frontier workers, and their dependent family members residing in the same country as the worker, are mutually waived. Under the terms of the agreement net liability between the two countries is calculated on a lump sum basis rather than an individual basis. By far the biggest part of the payment received from the UK on an annual basis relates to the provision of healthcare to UK pensioners residing in Ireland. An amount of €220 million was received from the United Kingdom in 2013.

Services for People with Disabilities

Questions (653)

Patrick Nulty

Question:

653. Deputy Patrick Nulty asked the Minister for Health further to Parliamentary Question No. 314 of 16 January 2014, the up-to-date position regarding a timeframe for the commencement of disability services with Beechpark in respect of a child (details supplied) in Dublin 15; the reason for the delay; and if he will make a statement on the matter. [5237/14]

Written answers

Minister for Health

As the particular issue raised by the Deputy relates to an individual case, this is a service matter for the Health Service Executive. Accordingly, I have arranged for the question to be referred to the HSE for direct reply to the Deputy.