Wednesday, 14 May 2014

Written Answers Nos. 47-54

Medical Card Eligibility

Questions (47)

Caoimhghín Ó Caoláin

Question:

47. Deputy Caoimhghín Ó Caoláin asked the Minister for Health in view of the fact that discretionary medical cards are provided for persons whose income or assets exceed the threshold but for whom purchase of care, services and equipment relating to the illness would create undue financial hardship; that the Health Service Executive has stated that a panel of clinicians examine each case and apply an adjustment for those above the income threshold to determine whether the illness will lead to financial hardship in the absence of availability of a medical card; that this is a form of health economic analysis and requires detailed information relating to the cost of illness, if he will provide details of the precise nature of this analysis for persons with motor neurone disease, which determines whether they are likely to incur undue financial hardship as a result of the progressive and terminal illness; and if he will make a statement on the matter. [21287/14]

Written answers

Minister of State at the Department of Health

Medical cards are provided to persons who are in the opinion of the HSE unable without undue hardship to arrange GP services for themselves and their dependants.

Under the legislation, assessment for a medical card is determined primarily by reference to the means, including the income and reasonable expenditure, of the applicant and his or her partner and dependants. Determination of eligibility is the responsibility of the HSE.

While there is no automatic entitlement to a medical card for persons with a specific illness or a disability, the HSE has discretion to award a medical card to avoid undue financial hardship, having regard to person’s or the family’s overall financial situation, even where the person’s means exceed the means assessment thresholds set out in the HSE's National Assessment Guidelines.

The HSE has established panel of Community Medical Officers to assist in the processing of applications for medical cards on a discretionary basis, where the income guidelines are exceeded but where there are difficult personal circumstances, such as an illness or physical disability.

The Community Medical Officer reviews the evidence of necessary medical expenses provided by the applicant to the HSE. As appropriate, he or she liaises with general practitioners, hospital consultants and other health professionals so that costs relating to the health circumstances of the applicant can be fully taken into account. Based on this full information the HSE is in a position to determine if the applicant is experiencing undue hardship in arranging medical services having regard to person’s overall financial situation.

This consistent process of assessment, which is not a form of health economic analysis, ensures that medical cards are issued to applicants whose income is above the guidelines thresholds but where illness or disability would lead to undue financial hardship for them in arranging GP services for themselves and their dependants.

Question No. 48 answered with Question No. 6.

Medical Card Reviews

Questions (49)

Caoimhghín Ó Caoláin

Question:

49. Deputy Caoimhghín Ó Caoláin asked the Minister for Health if he will confirm that, in the context of the ongoing reviews of provision of medical cards, all survivors of symphysiotomy will continue to retain their entitlement to medical cards, which are not subject to means testing and which are designated SOS, and which they have been given as part of the package of health supports for such survivors; and if he will make a statement on the matter. [21286/14]

Written answers

Minister for Health

My priority continues to be to ensure that the women who have undergone surgical symphysiotomy continue to have their health needs comprehensively and professionally met. 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. All of these services are available on request by the women from the HSE nominated Symphysiotomy Liaison Officers.

Medical cards granted to women on the basis of having undergone a surgical Symphysiotomy are subject to review by the HSE to confirm a continued need for the service. Once this is confirmed, cards are automatically reissued.

Question No. 50 answered with Question No. 13.

Orthodontic Service Provision

Questions (51)

Charlie McConalogue

Question:

51. Deputy Charlie McConalogue asked the Minister for Health to explain the reason there is currently no orthodontic consultants available in Letterkenny General Hospital; when he will appoint a temporary locum to address the urgent situation that has been allowed to develop there with respect to waiting lists; and if he will make a statement on the matter. [21284/14]

Written answers

Minister for Health

As this is a service matter, I have asked the HSE to respond directly to the Deputy.

Drug Treatment Programmes Policy

Questions (52)

Maureen O'Sullivan

Question:

52. Deputy Maureen O'Sullivan asked the Minister for Health in respect of the national substance misuse strategy 2009-16 review published in March, if he will outline the policy level activities carried out in response to rising polydrug use here and the actions carried out so far under the research and information pillar, supply pillar and prevention pillar in respect of polydrug use; and if he will make a statement on the matter. [21151/14]

Written answers

Minister of State at the Department of Health

I assume that the Deputy is referring to the National Drugs Strategy 2009-2016 Annual Progress Report for 2013, which was published on the Department of Health website on 26 March 2014.

Solid progress is being made across the 63 Actions of the Strategy, which are based around the five pillars of supply reduction, prevention, treatment, rehabilitation and research and a number of actions are completed and fully implemented. The annual progress report provides a detailed account of the policy level activities and actions carried out across the pillars of the Strategy.

Drug misuse continues to be one of the most significant challenges facing our country. It is highly destructive and has devastating effects on individuals, relationships, families, communities and society in general. In recent years, the nature and scale of the problem has changed, due to the increasing geographic dispersal of problem drug use, the increased prevalence of polydrug use, the increased strength of cannabis, and the emergence of new psychoactive substances. In consequence, the HSE has re-oriented their services in order to develop a comprehensive integrated addiction treatment service capable of dealing with all substances. In addition, the target of providing access to substance misuse treatment within one month of assessment is being largely achieved.

The Deputy may wish to note that the National Advisory Committee on Drugs and Alcohol will shortly be publishing the final bulletin arising from the Drugs use in Ireland and Northern Ireland 2010/2011 Drugs Prevalence Survey, which will focus on polydrug use.

Mental Health Services Provision

Questions (53)

Colm Keaveney

Question:

53. Deputy Colm Keaveney asked the Minister for Health to set out the actions taken following the findings of recent audits into the compliance of the notification and investigation of incidents of sudden unexplained death of persons in community mental health services along with associated legislative requirements and the Health Service Executive policy and procedures; and if he will make a statement on the matter. [21119/14]

Written answers

Minister of State at the Department of Health

It is important that mental health services, as with all parts of the health service, are subject to periodic review or audit where issues of potential concern are identified. Such review processes facilitate services to improve the quality and safety of the care and treatment provided, by identifying any matters of concern and making recommendations as to the steps necessary to address these.

In 2013, as part of its patient safety and quality process, the HSE Mental Health services and Quality and Patient Safety Directorates requested an audit of compliance with regulatory requirements and HSE policies and procedures in relation to the notification and investigation of incidents of sudden, unexplained deaths of persons in community mental health services.

The HSE audit report was completed on 15 January, 2014. The report concluded that, based on the information submitted, the audit team could not provide assurance that incidents of sudden, unexplained death of persons in community mental health services were being notified in accordance with HSE policy and procedures, nor could it provide assurance that incidents of this nature were investigated using the systems analysis methodology.

The audit report made a series of detailed recommendations in relation to the notification, recording and investigation of sudden unexplained deaths of users of mental health services. The HSE is taking steps to ensure that each of these is addressed. In March 2014 the National Director of Mental Health Services issued a memorandum to all relevant managers, re-emphasising the requirements in relation to the reporting of sudden unexplained deaths. Work is under way in conjunction with the Mental Health Commission in respect of two recommendations. The Executive is also working to ensure that the other shortcomings identified are addressed through appropriate performance management and service improvement processes.

Maternity Services

Questions (54)

Clare Daly

Question:

54. Deputy Clare Daly asked the Minister for Health further to Parliamentary Question No. 813 of 30 April 2014 and in respect of the Health Service Executive service plan, in which he stated that the plan was based on the dual challenge of protecting patient outcomes and reducing costs, the reason midwifery-led maternity care is not being promoted as the best option for safety and cost. [21142/14]

Written answers

Minister for Health

As the Deputy is aware, my Department, in conjunction with the HSE, is preparing a National Maternity Strategy which will determine the future model of maternity services to ensure that women have access to safe, high quality care in a setting most appropriate to their needs, ensuring access at all times to the right level of care and support, and providing choice insofar as is possible. The Strategy will incorporate a review and evaluation of current services and therefore provide us with the opportunity to take stock of current services and identify how the quality and safety of care provided to women and their babies can be further improved. It is anticipated that the strategy will define the key principles underpinning models of care, and in that context, the issue of midwifery led care will be considered.