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Tuesday, 11 Nov 2014

Written Answers Nos. 109-123

Midwifery Services

Questions (109)

Caoimhghín Ó Caoláin

Question:

109. Deputy Caoimhghín Ó Caoláin asked the Minister for Health his Department's intentions to the 29 women who had engaged the services of a community midwife (details supplied) now not in a position to provide their professional advices and supports due to the arbitrary withdrawal of their indemnification; the way it was possible to offer the person a return to their indemnified practice with the proviso of having a second community midwife in situ in an overseeing capacity when there is clearly no such availability as has been stated by the national director of community care; and if he will make a statement on the matter. [42758/14]

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Written answers

I will answer the first part of the question put down by the Deputy. As the second issue raised is an operational matter, I have forwarded it to the HSE for direct reply. If you have not received a reply from the HSE within 15 working days please contact my Private Office and they will follow up the matter with them.

I have been informed by the HSE that the total number of clients of Ms Canning with signed contract agreements with the HSE is 13. Of this number, 5 mothers have delivered since Ms Canning's suspension, in the care of an alternative Self Employed Community Midwife (SECM), a hospital or mothers making alternative arrangements.

The remaining 8 mothers were offered alternative options. Another 3 have accepted the offer of an alternative SECM, 1 has decided to go to the Maternity Hospital for delivery, 3 have no SECM available to them and have been referred to the hospital service and 1 has declined the SECM offered and instead accessed private care.

I would advise any mothers-to-be who are not contracted with the HSE should contact their designated midwife officers to explore the options available to them. All other HSE maternity services within the maternity hospital systems are available to all mothers-to-be.

Maternity Services

Questions (110)

Clare Daly

Question:

110. Deputy Clare Daly asked the Minister for Health in view of his undertaking to the Oireachtas Joint Committee on Health and Children that there will be a consultation process as part of an overall national review of maternity services here, with special reference to best evidence international models, the reason he is permitting the office of nursing and midwifery services in the Health Service Executive to produce a second version of its memorandum of understanding, with extremely restrictive criteria governing the practice of the few available self-employed midwives, limiting options for women seeking a home birth, and unconnected with best evidence international models, before the overall review of all aspects of the maternity services is even undertaken [42781/14]

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Written answers

I will answer the first part of the question put down by the Deputy. As the second issue raised is an operational matter, I have forwarded it to the HSE for direct reply. If you have not received a reply from the HSE within 15 working days please contact my Private Office and they will follow up the matter with them.

A National Maternity Strategy is being developed by my Department in conjunction with the HSE. A literature review, which was commissioned by the Department, is informing the development of a maternity service policy paper. Following the finalisation of the policy paper a working group will be established with a view to completing the Strategy. This will include a consultation process with all stakeholders including mothers/mothers-to-be in order to create the best Maternity service in Ireland for the future.

Mental Health Services Funding

Questions (111)

Colm Keaveney

Question:

111. Deputy Colm Keaveney asked the Minister for Health the position regarding the underspend of €46.8 million in the mental health budget in 2013; and if he will make a statement on the matter. [42765/14]

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Written answers

Budgetary and other pressures within the HSE delayed the full utilisation of the €35 million allocated in both 2012 and 2013. The underspend in planned Mental Health expenditure and the timing of the recruitment of staff developments was also due to the time required to get various programmes up and running, such as Counselling in Primary Care, Enhanced Teamworking, Mental Health Information System, Clinical Programmes and the opening of additional in-patient beds.

Additional funding of €35 million in Budget 2015 brings to €125 million the total investment for mental health services since 2012, for the development and modernisation of the services in line with the recommendations of A Vision for Change, mostly in the way of additional posts to strengthen Community Mental Health Teams for both adults and children. The additional funding is also being used to enhance specialist community mental health services for older people with a mental illness, those with an intellectual disability and mental illness, forensic mental health services and suicide prevention initiatives.

At the end of September an additional 770 posts of the 890 provided for in 2012 and 2013 had been recruited with the remainder at various stages in the recruitment process, with some difficulties in identifying some outstanding candidates for geographic and qualification reasons. Therefore, approximately 77% of combined 2 years posts have taken up duty.

In relation to 2014, while €20 million was provided for mental health services, the HSE National Service Plan outlined that this expenditure would be phased-in, in order for the HSE to live within the overall available resource in 2014. Accordingly, it was decided that the recruitment of 2014 posts would be commenced to provide for posts to come on stream during the last quarter of 2014. To this end, and informed by the analysis carried out, some 200 posts have now been identified from the 2014 allocation and the recruitment process has now commenced. It is important to stress, however, that the entire underspent funds have been made available to Mental Health for spend in 2014 and subsequent years.

Hospital Accommodation Provision

Questions (112)

Bernard Durkan

Question:

112. Deputy Bernard J. Durkan asked the Minister for Health the extent to which he and his Department have evaluated the total requirement of hospital beds throughout the public health sector; if any particular hospitals have been identified in this regard; if he has received any submissions or made any suggestion in this regard which may impact on the degree to which the public health sector is capable of meeting demand; and if he will make a statement on the matter. [42788/14]

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Written answers

As this is a service matter, I have asked the HSE to respond to you directly. If you have not received a reply from the HSE within 15 working days please contact my Private Office and they will follow up the matter with them.

Maternity Services

Questions (113)

Denis Naughten

Question:

113. Deputy Denis Naughten asked the Minister for Health when he expects the review of maternity services to be completed; and if he will make a statement on the matter. [42743/14]

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Written answers

My Department, in conjunction with the HSE, is currently preparing a National Maternity Strategy, which will provide the strategic direction for the optimal development of safe and high quality maternity services. As a first step a review of national and international literature on the organisation and delivery of maternity services was commissioned by my Department. This review has now been completed and is informing the development of a high level policy paper. Following the finalisation of this paper, a working group will be established with a view to completing the Strategy in 2015. In the meantime the HSE has been asked to undertake a review and evaluation of current maternity services.

General Practitioner Services

Questions (114)

Seán Ó Fearghaíl

Question:

114. Deputy Seán Ó Fearghaíl asked the Minister for Health if he will honour the commitment with regard to no fees for general practitioner care; and if he will make a statement on the matter. [42769/14]

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Written answers

The Government committed to introducing, on a phased basis, a universal GP service without fees within its term of office, as set out in the Programme for Government. The Government has commenced this process in respect of all children under 6 years. The Health (General Practitioner Service) Act 2014, which provides an entitlement for all children aged under 6 to a GP service without fees, was enacted on 25th July 2014. Under a Framework Agreement, the Department of Health, the HSE and the IMO are engaged intensively on the introduction of GP services without fees for children aged under 6.

In July 2014, the Government approved the drafting of a Bill to amend the Health Act 1970 to provide a GP service, without fees, for all persons aged 70 years and over. Drafting of the Bill by the Department and the Attorney-General’s Office is nearing completion and this will allow for the introduction of access to GP care without fees for persons aged 70 and over.

The Government's aim is to have the first two phases for the under-6s and over-70s implemented early next year subject to the conclusion of the present discussions and the completion of a fee-setting process. By the end of next year, approximately half of the population will have access to GP services, without charges.  That’s a major step on the way to universal health care.

Some GPs have raised concerns that there could be a high level of inappropriate or unnecessary attendances at GP practices when a service is free and have suggested that there could be an option for a GP to apply a nominal fee to deter such unnecessary visits to a GP, and free up GP time for genuine patients. However, the Minister for Health is currently implementing the phased introduction of a universal GP service without charges in line with existing and planned legislation.

Dental Services Provision

Questions (115)

Caoimhghín Ó Caoláin

Question:

115. Deputy Caoimhghín Ó Caoláin asked the Minister for Health the steps he is taking to restore access for children to tooth extraction under general anaesthetic, as deemed necessary, in the Dublin area; the reason this element of the primary care dental services, available at St. James's Hospital, Dublin up to 30 September 2014, has ceased; if his attention has been drawn to the distress that this withdrawal of service is causing; and if he will make a statement on the matter. [42759/14]

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Written answers

The dental clinic in St. James's Hospital, which provided dental extractions under general anaesthetic for children in the greater Dublin area, ceased in October 2014 due to problems with the suitability of the building. The HSE is seeking a long term solution for the provision of a service for children with these needs. In the meantime, urgent cases requiring immediate treatment due to pain or swelling are being dealt with as necessary at private centres in Dublin and at no cost to the families. Parents who have concern in relation to this matter should liaise closely with their local public dental clinic, and particularly so if there is any deterioration or pain being experienced since their last dental assessment.

Cancer Screening Programmes

Questions (116)

Mary Mitchell O'Connor

Question:

116. Deputy Mary Mitchell O'Connor asked the Minister for Health if he will provide an update on extending BreastCheck since confirming it will be extended on 14 October 2014; and if he will make a statement on the matter. [42736/14]

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Written answers

Breast cancer survival rates in Ireland have improved significantly in recent years through a combined approach of screening, symptomatic detection and improved treatment. Additional funding is being provided to commence the extension of the BreastCheck screening programme next year to women aged 65 to 69 years of age. Screening of the extended cohort will commence towards the end of 2015 and will be expanded on an incremental basis. The additional eligible population is approximately 10,000 and, when fully implemented, 540,000 women will be included.

Health Insurance Company Payments

Questions (117)

Billy Kelleher

Question:

117. Deputy Billy Kelleher asked the Minister for Health his views on private patients in public hospitals being charged bed rates when they are accommodated in trolleys, chairs or recliners as part of overnight stays; and if he will make a statement on the matter. [42773/14]

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Written answers

The Health Act 1970 (as amended) provides that all persons ordinarily resident in the country are entitled, subject to certain charges, to all in-patient public hospital services in public wards including consultant services and out-patient pubic hospital services including consultants services.

Section 55 provides that the HSE may provide private in-patient services to persons who are not entitled to, or who do not have or have waived eligibility to public in-patient services. An essential element of the eligibility arrangements is that the public or private status of a patient must be specified on admission to hospital.

Section 55 of the Health Act 1970 (as amended) also provides for the charging of private in-patients. Where a patient elects to be treated privately by a consultant the hospital must treat that patient as a private patient. Persons who opt to be private on admission to hospital are liable for the fees of all consultants involved in his or her care and for hospital charges under Section 55 for that episode of care. The hospital charge applicable depend on the hospital treating the patient and on whether a person is accommodated in a single or multiple occupancy room or on a day case basis. The application of a charge by a hospital for in-patient services is obligatory under the legislation, irrespective of whether the patient occupies a public designated bed or private designated bed, as it relates to the private service provided.

The private in-patient charge goes towards meeting part of the cost of providing the hospital’s services to private patients, for example, the cost of non-consultant doctors, nursing, diagnostic services (such as x-rays and other scans), laboratory services (such as blood tests etc.), medicines, and capital costs.

In the case of a chemotherapy or dialysis patient, best practice is to treat him/her in a seated or reclining position, on a therapy chair or a recliner, rather than on a bed. Treatment trolleys are routinely used in day surgery procedures such as colonoscopy. It is therefore appropriate to charge for the private service provided.

The private in-patient charges do not apply to patients receiving accident and emergency treatment. They only apply where the person has been admitted to the hospital as a private in-patient.

Long-Term Illness Scheme Applications

Questions (118)

Noel Harrington

Question:

118. Deputy Noel Harrington asked the Minister for Health the reason there is a six-month delay in having an application for a long-term illness card processed in the Health Service Executive south region; and if he will make a statement on the matter. [42733/14]

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Written answers

Under the Health (Pricing and Supply of Medical Goods) Act 2013, the Health Service Executive (HSE) has statutory responsibility for the administration of the primary care schemes, including the Long Term Illness Scheme, therefore the matter has been referred to the HSE for attention and direct reply to the Deputy.

If you have not received a reply from the HSE within 15 working days please contact my Private Office and they will follow up the matter with them.

General Medical Services Scheme Administration

Questions (119)

Robert Troy

Question:

119. Deputy Robert Troy asked the Minister for Health if he will provide an update on whether the Health Service Executive will include sofosbuvir or Sovaldi in the general medical scheme and community drugs schemes. [42775/14]

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Written answers

The HSE has statutory responsibility for decisions on pricing and reimbursement of medicinal products under the community drug schemes in accordance with the provisions of the Health (Pricing and Supply of Medical Goods) Act 2013.

The HSE received an application in February 2014 for the inclusion of Sofosbuvir, the first of a new generation of drugs for the treatment of Hepatitis C, in the GMS and community drugs schemes. The application is being considered in line with the procedures and timescales agreed by the Department of Health and the HSE with the Irish Pharmaceutical Healthcare Association for the assessment of new medicines. In accordance with these procedures, the HSE asked the National Centre for Pharmacoeconomics to conduct a pharmacoeconomic evaluation of the new product in June 2014. This evaluation will provide detailed information on the potential budget impact of the medicine. It will also assess whether the product is cost effective at the price quoted by the manufacturer. The Report by the National Centre for Pharmacoeconomics, which is expected to be published shortly, is an important input to assist the HSE in its decision making process.

The HSE assessment process is intended to arrive at a decision on the funding of new medicines that is clinically appropriate, fair, consistent and sustainable. In advance of this decision the HSE has engaged with the pharmaceutical companies regarding an early access programme for a cohort of individuals with advanced liver disease and who require immediate treatment.

The Department has also established an advisory group to examine the feasibility and cost implications of a multi-annual approach to the clinical and public health management of hepatitis C. This group will furnish a report to the Minister for Health on this issue when it has completed its work.

Medical Records

Questions (120)

Jonathan O'Brien

Question:

120. Deputy Jonathan O'Brien asked the Minister for Health the location of the medical records, including the birth registers and the theatre registers, for each year from 1950 to 2007, inclusive, relating to maternity and obstetric services formerly provided at ​St Finbarr's ​Hospital, Cork, under arrangements pursuant to maternity services legislation; and if he will make a statement on the matter. [42750/14]

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Written answers

I am advised by the HSE that all available historic records for St Finbarr’s Hospital are stored in an offsite storage facility.

Health Services Staff Data

Questions (121)

Joe Higgins

Question:

121. Deputy Joe Higgins asked the Minister for Health further to Parliamentary Question No. 173 of 9 October 2014 the number and percentage of the 13,743 Health Service Executive staff on fixed-term or specified-purpose contracts as of August 2014 who were employed through employment agencies; if he will provide details of the fees, total amount and average percentage of employee salary paid to agencies in this respect; and if he will provide the same information for any additional agency staff working in the HSE not included in those figures. [42790/14]

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Written answers

I have asked the HSE to respond to the Deputy directly on this matter. If you have not received a reply from the HSE within 15 working days please contact my Private Office and they will follow up the matter with them.

Hospital Waiting Lists

Questions (122)

Charlie McConalogue

Question:

122. Deputy Charlie McConalogue asked the Minister for Health the current waiting times in Letterkenny General Hospital for an initial outpatient appointment for a consultant in each area of specialism for urgent and routine appointments and the number of patients waiting in each of these categories; and if he will make a statement on the matter. [42761/14]

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Written answers

As this is a service matter, I have asked the HSE to respond to you directly. If you have not received a reply from the HSE within 15 working days please contact my Private Office and they will follow up the matter with them.

Medical Card Reviews

Questions (123)

Pat Deering

Question:

123. Deputy Pat Deering asked the Minister for Health if he will provide an update on the process of medical card reviews. [42738/14]

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Written answers

I understand the Deputy is referring to the Keane report - The Report of the Expert Panel on Medical Need for Medical Card Eligibility. Eligibility for health services in Ireland, as set out in the Health Act 1970 as amended, is based primarily on ordinary residence and means. All people ordinarily resident in the State are eligible for publicly-funded hospital services. In addition, about two-fifths of the population are eligible for publicly-funded primary care services.

The Deputy will be aware that the Director-General of the HSE established an Expert Panel to examine and recommend the range of medical conditions that would be considered as a basis of eligibility for health services. The Expert Panel was chaired by Prof Frank Keane, Past President of the Royal College of Surgeons Ireland and Clinical Lead, National Clinical Programme for Surgery. The panel included a range of 23 clinical experts from primary care, specialist services and therapies. It also included a patient representative. The work of the Expert Panel was also informed by on-line public consultation and the convening of a patient representative forum to consider the issues.

The Keane report was received by my Department last month and I am considering its findings. The Keane report acknowledged that eligibility is a complex and challenging issue. It is widely known that the report concluded that it is neither feasible nor desirable to list conditions for medical card eligibility.

This is a very detailed report and when I have finished considering its conclusions, discussed them with the HSE and consulted as necessary with the Minister for Public Expenditure and the Attorney General, I will be reporting to Government on the matter.

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