Written Answers Nos. 591-606
592. Deputy Seán Conlan asked the Minister for Health the reason a six year old child, details supplied, in County Monaghan has not received any form of speech and language or occupational therapy since August 2013; and if he will make a statement on the matter. [15361/14]
View answerAs the issue raised by the Deputy relates to an individual case, this is a service matter for the Health Service Executive. I have asked the HSE to look into the particular matter raised and to reply directly to the Deputy.
593. Deputy Caoimhghín Ó Caoláin asked the Minister for Health when a person (details supplied) in County Meath will receive a hospital appointment; and if he will make a statement on the matter. [15366/14]
View answerA 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.
594. Deputy Seamus Kirk asked the Minister for Health the number of paramedic staff who are employed on the ambulance service in the north east; the number of staff on full pay who are not being utilised as part of the service; and if he will make a statement on the matter. [15369/14]
View answerAs this is a service matter, I have asked the HSE to respond directly to the Deputy.
595. Deputy Willie Penrose asked the Minister for Health when a decision will be made on an appeal against the refusal of a medical card application in respect of a person, details supplied, in County Westmeath; and if he will make a statement on the matter. [15380/14]
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.
596. Deputy Willie Penrose asked the Minister for Health the reason a person (details supplied) in County Westmeath who submitted additional information regarding the interpretation of accounts, which were clearly analysed incorrectly by the PCRS section, has not had same reviewed in the context of this submission; if same will now be addressed; and if he will make a statement on the matter. [15387/14]
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.
597. Deputy Willie Penrose asked the Minister for Health when a medical card will issue to a person (details supplied) in County Westmeath who submitted additional information requested; and if he will make a statement on the matter. [15388/14]
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.
598. Deputy Bernard J. Durkan asked the Minister for Health the extent to which intensive or any research continues to be conducted here with a view to determination of the cause or causes of autism, Asperger's syndrome or similar conditions; the extent to which comparisons have been made with other European countries in respect of determination of the origins, whether genetic or otherwise; the degree to which the number of cases reported in this country compares with the averages in other European countries; and if he will make a statement on the matter. [15421/14]
View answerAutism is a developmental disorder that appears in the early years of life and affects the brain's normal development in the areas of social interaction and communication. While the exact cause of these developmental abnormalities remain unclear, genetic and other non genetic factors such as brain development during pregnancy are thought to play a role. Autism is described as a spectrum disorder (Autism Spectrum Disorder or ASD) that can have a varied presentation of characteristics ranging from mild to severe. Many individuals with autism, due to the complexity of their presentation, may have a primary diagnosis of intellectual disability or mental health co-morbidity.
Although there has been an increased demand in recent years for assessment for ASD it is not clear whether this is due to increased prevalence or to a greater awareness and recognition of the need for earlier intervention. The Health Service Executive does not currently collect information specifically on adults and children identified with Autism on a national basis on the basis of diagnosis. Information pertaining to diagnosis is specifically excluded from the National Intellectual Disability Database as the database is not designed as a medical epidemiological tool. Accordingly the database does not record the incidence of autism or any other disability. The 2011 National Council for Special Education (NCSE) study on prevalence of special educational needs in Ireland (A Study on the Prevalence of Special Educational Needs, Joanne Banks and Selina McCoy, Economic and Social Research Institute) includes autism and estimates that prevalence for ASD is 1 in 100. This is in line with the figure of .9% reported by the Centre for Disease Control in the US.
Research was initiated in 2004 into autism under the auspices of the HRB as part of the Autism Genome Project - a collaboration of autism researchers internationally aimed at understanding susceptibility to ASD. The research groups for this work were based in Trinity College Dublin and University College Dublin. This research investigated the genetic risk factors in ASD by pooling DNA obtained from a large international sample of individuals and their families, including many Irish families. Genetic screening was then employed to identify (i) genetic variants that might increase the risk of autism and (ii) structural changes in the DNA of people with autism. In parallel, complete clinical information was gathered on participants and the clinical and genetic information was combined in the analysis. The main outcome showed that although ASDs have a substantial genetic basis, most of the known genetic risk has been traced to rare structural gene variants. These gene variants were both de novo (arising for the first time in individuals) or inherited, implicating many novel ASD genes and genes involved in neurodevelopment.
In relation to ongoing research, I understand that an Autism Research Group in Trinity College Dublin is focusing on understanding the genetic and neurobiological underpinnings of autism using genetic and neuroimaging methodologies. The Group is funded through a variety of funding agencies and collaborates widely nationally and internationally.
599. Deputy Bernard J. Durkan asked the Minister for Health the full extent of any research ongoing in relation to the various life-threatening illnesses currently affecting the broadest age profile of the population, children and adults of all ages; the degree to which the origins of such conditions continue to be monitored; the number of incidents compared with those in other jurisdictions throughout Europe; the extent to which any information can be obtained to ascertain the reason for a higher or lower level of conditions in particular regions, nationally and overseas; and if he will make a statement on the matter. [15422/14]
View answerMonitoring of population health takes place at a number of levels - nationally, at EU level, and internationally. This includes vital statistics on causes of death, notification of infectious diseases, disease registers, data on hospital discharges, and population-based health survey data. The reasons for higher or lower prevalence and/or mortality by region and across countries can vary according to the condition and can be due to a range of factors. These may include lifestyle determinants, genetic variables, socio-economic factors, demographic variations and a number of other potential explanatory variables. Much of the public health research into major causes of morbidity and mortality is devoted to increasing our understanding of these underlying causes to improve both treatment and prevention.
Health research projects in Ireland, including those related to principal life-threatening illnesses, can take place in many fora including Universities, hospitals, and research projects funded by my Department through the Health Research Board, etc. Information on these research projects is not readily available in my Department.
600. Deputy Bernard J. Durkan asked the Minister for Health the extent to which central procurement and generic prescribing have been each identified and assessed for potential to reduce health service costs without in any way affecting the quality and efficacy of the service; and if he will make a statement on the matter. [15423/14]
View answerMost drugs and medicines which are paid for by the HSE are supplied to patients through over 1,800 community pharmacies who, in turn, purchase them from wholesalers or, to a lesser extent, directly from drug manufacturers. The current pharmacy based model results in over 70 million items being dispensed annually through local pharmacies across the State, including low population centres in rural areas. It enables pharmacies to receive deliveries each day from multiple wholesalers ensuring that all patients have continued access to essential medicines without delay. Under this model, as the drugs are purchased by individual pharmacies with no direct input by the HSE, there is no scope for the type of central procurement arrangement envisaged by the Deputy.
Establishing an alternative centralised distribution centre capable of distributing 70 million items across the State would be extremely difficult to achieve and would absorb any potential savings available to the HSE from directly purchasing medicines.
Under the Memorandum of Understanding with the Troika, Ireland committed to increasing the share of generic drug usage in the medium-term. In Quarter 4 2013 generic products accounted for 58% of the total off-patent market by volume. My Department has set a target of achieving 70% generic penetration of the off-patent market by volume by 2016.
A number of enabling measures are being implemented to achieve this target, in particular, the introduction of generic substitution and reference pricing under the Health (Pricing and Supply of Medical Goods) Act 2013.
In October 2012 a new agreement on the pricing and supply of generic drugs was reached with the Association of Pharmaceutical Manufacturers in Ireland (APMI), which represents the generic drugs industry. Since 1 November 2012, the maximum price the HSE pays for generic products is 50% of the initial price of an originator medicine. Recent negotiations with the APMI have resulted in agreement on additional price reductions and, from 1 May 2014, the maximum price the HSE will pay will be 40% of the initial price of an originator medicine. This will result in the price differential between off-patent drugs and most generic equivalents increasing from 5% currently to approximately 20%.
The Medicines Management Programme within the HSE has introduced the preferred drugs initiative which facilitates more cost-effective prescribing particularly in relation to high-cost medicines. It continues to engage with general practitioners to reinforce the message around safe, effective and cost-effective prescribing including generic prescribing.
601. Deputy Bernard J. Durkan asked the Minister for Health the extent to which drug costs have fluctuated in each of the past five years to date; the way this continues to affect the budgetary situation; and if he will make a statement on the matter. [15424/14]
View answerThe cost to the HSE of drugs and medicines supplied under the GMS, Drug Payment and Long Term Illness schemes between 2008 and 2012 are set out below (corresponding figures for 2013 are not yet available).
|
YEAR |
COST |
|
2012 |
€1.53 billion |
|
2011 |
€1.46 billion |
|
2010 |
€1.53 billion |
|
2009 |
€1.65 billion |
|
2008 |
€1.59 billion |
The figures above include dispensing fees and mark-ups paid to pharmacists.
My Department and the HSE continue to implement a medicines pricing policy which aims to reduce the prices for medicines/improve value for money whilst also maintaining continuity of supply and availability of essential medicines. These aims are balanced in an attempt to maximise public health gain from available resources. As part of the pricing policies there has been a price freeze (i.e. no price increases allowed except in exceptional circumstances) for a number of years.
Over the last few years thousands of price reductions on medicines have occurred. For example, the price of over 500 different presentations of various medicines reduced by between 5% and 29% on the 1st November 2013 as a consequence of agreements reached with the Irish Pharmaceutical Healthcare Association (IPHA) and the Association of Pharmaceutical Manufacturers of Ireland (APMI). In overall terms, price reductions of the order of 30% per item reimbursed have been achieved between 2009 and 2013; the average cost per item reimbursed is now running at 2001/2002 levels.
602. Deputy Bernard J. Durkan asked the Minister for Health the extent to which orthodontic services continue to be made available to children and teenagers with particular reference to follow-up on school medical examinations; and if he will make a statement on the matter. [15425/14]
View answerThe Public Dental Service of the HSE provides dental services for children up to 16 years of age and persons with special needs through its dental clinics. All HSE dental clinics prioritise emergency care for children up to 16 years of age, treatment for special needs patients and screening of children aged from 11 to 13 years, including referral for orthodontic services where necessary. An independent national review of orthodontic services, commissioned by the HSE, has recently been completed. The key issue highlighted by the review is that the Orthodontic Service should be fully integrated within the Primary Care Service. This is under consideration by the HSE to be implemented as part of the HSE's Transformation Programme. Pilot schemes, which will involve the use of orthodontic therapists, are currently being introduced. It is expected that these changes will have a positive impact on waiting times.
603. Deputy Bernard J. Durkan asked the Minister for Health the degree to which he will continue to support public sector nursing homes and hospitals caring for older persons in view of the high quality of service available to the public sector, notwithstanding competition from the private sector; if he will ensure that the application of standards by the Health Information and Quality Authority is not used as a means to increase the costs in the public sector over the private sector; and if he will make a statement on the matter. [15426/14]
View answerGovernment 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, including the provision of financial assistance under the Nursing Homes Support Scheme. We are committed to the provision of a quality public nursing home service underpinned by a regulatory system of registration and inspection.
The National Quality Standards for Residential Care Settings for Older People in Ireland provide the framework for Health Information and Quality Authority to assess whether residential services are providing high quality, safe and effective services and supports to residents. All nursing homes are subject to the same core standards and regulations in relation to quality and safety in order to ensure the well-being of their residents.
604. Deputy Bernard J. Durkan asked the Minister for Health the full complement of general hospital beds currently available on a regional basis throughout the country in the public health sector; the number of similar beds in the private sector; and if he will make a statement on the matter. [15427/14]
View answerThe information requested by the Deputy is collated by the Business Intelligence Unit within the Health Service Executive. Therefore, I have asked the Executive to respond directly to the Deputy in relation to this matter. In relation to the Deputy's query regarding private beds; my Department has no role or function.
605. Deputy Bernard J. Durkan asked the Minister for Health the extent to which he and his Department have curtailed expenditure overruns throughout the service; and if he will make a statement on the matter. [15428/14]
View answerThe Revised Estimate for 2014 for the Health group of Votes provides for gross expenditure of €13.164 billion comprising €12.774 billion in current expenditure and €390m in capital expenditure. 2014 will be another extremely challenging year for the health services. Significant cost extraction is required with €619m in savings to be achieved. In Net Vote terms, the March Issues indicate a cumulative deficit of €49m.
There is ongoing and intensive engagement each month between officials of my Department, DPER and the HSE in the context of regular monitoring of expenditure. The HSE's Performance Assurance Report and the more detailed Management Data Report are published monthly on the HSE's website - www.hse.ie - and provide an overall analysis of key performance data from Finance, HR, Hospital and Primary & Community Services.
The HSE is pro-actively engaged in internal efforts to maximise savings and cost containment plans and to ensure that additional measures are identified and safely implemented to mitigate any projected deficits which are within HSE direct control, while engaging on an ongoing basis with my Department. As well as the wider performance management of the acute system in 2014 a more targeted approach with individual poorer performing hospitals is being undertaken. The HSE will continue to engage with the acute hospital sector in relation to the 2014 savings measures and cost containment initiatives.
606. Deputy Bernard J. Durkan asked the Minister for Health the total number of reports of various infections arising from MRSA or other hospital bugs on a monthly basis in each of the past four years to date; the action taken arising therefrom; and if he will make a statement on the matter. [15429/14]
View answerThe prevention of Healthcare Associated Infections (HCAIs) and colonisation/infection of patients with antimicrobial-resistant organisms (AMR) such as MRSA is one of my priorities in protecting patient safety. HCAIs represent a major cause of preventable harm and increased healthcare costs.
The prevalence of MRSA has dropped considerably in recent years. There has been a decrease of 62.5% in reported cases of MRSA from 2006 to 2013. However, there are concerns about the rates of resistance of other organisms as detailed in the EARS- Net Report referred to below.
The Health Protection Surveillance Centre (HPSC) collates information from hospitals on healthcare associated infections and antimicrobial resistant organisms such as MRSA,Clostridium difficile etc. The most recent European Antimicrobial Surveillance System Report (EARS - Net) for Quarter 4, 2013 was published on March 27th. The full Report is available at http://www.hpsc.ie/hpsc/A-Z/MicrobiologyAntimicrobialResistance/EuropeanAntimicrobialResistanceSurveillanceSystemEARSS/EARSSSurveillanceReports/2013Reports/.
The HSE has implemented a number of national initiatives in the control and prevention of HCAIs for many years, including:
o SARI 2001-2010 (The Strategy for the Control of Antimicrobial Resistance in Ireland) which specifically outlined the national strategy for prevention of AMR and was launched by the Minister of Health in 2001.
o HSE ' Say No to Infection' which focused on both HCAIs and AMR, launched in 2007
o The RCPI & HSE National Clinical Programme for the prevention and control of HCAIs and AMR which commenced in late 2010.
o Public reporting of HCAIs and AMR in Irish acute hospitals:
- HCAIs Prevalence Study 2006 and 2012
- S. aureus bloodstream infection (reported quarterly since 2007) – this includes public reporting of MRSA rates per hospital
- Alcohol hand rub consumption (reported bi-annually since 2007)
- Antibiotic consumption (reported bi-annually since 2007)
- Hand hygiene compliance (reported bi-annually since 2011)
The overall aim of the National Clinical Programme for the prevention and control of HCAIs and AMR is that every healthcare worker and all parts of the healthcare system recognise that the prevention and control of HCAIs and AMR is a key element of clinical and non-clinical governance. Our healthcare systems have processes in place to ensure safe healthcare is reliably delivered irrespective of the healthcare setting. The programme focuses on getting three basic practices right every time we care for our patients, these are hand hygiene, using antimicrobials appropriately (antimicrobial stewardship) & preventing medical device-related infections i.e., IV lines/drips, urinary catheters. If the above three measures are applied consistently and reliably every time healthcare workers care for their patients/residents/client then a significant proportion of HCAIs, including that caused by AMR will be prevented.
While I welcome the reducing trend in reported rates of MRSA in Ireland, MRSA rates are comparably high with other countries. We must systematically build our actions and processes to continue to reduce the prevalence of MRSA in Ireland.
In December last I launched and endorsed the second National Clinical Guideline, Prevention and Control Methicillin-Resistant Staphylococcus aureus (MRSA). This National Clinical Guideline provides practical guidance on prevention and control measures for MRSA to improve patient care, minimise patient morbidity and mortality and to help contain healthcare costs. The guideline has been developed for all healthcare staff involved in the care of patients, residents or clients who may be at risk of or may have MRSA in acute hospitals, obstetrics and neonates, nursing homes/long stay residential units and the community.
I might add that I have ensured that Patient Safety has been made a priority within the HSE's Annual Service Plan through specific measures focused on quality and patient safety including HCAIs, Medication safety and implementation of Early Warning Score systems. My officials meet the HSE each month on the Service Plan and patient safety is a standing item on that agenda.
