Written Answers Nos. 131-150
131. Deputy Catherine Murphy asked the Minister for Health if he will provide an update to the co-operation activities which have been carried out under the memorandum of understanding on health regulation, training, promotion, hospital standards and so on, with the People's Republic of China, since August 2012; if further agreements are being negotiated or intended; and if he will make a statement on the matter. [8428/15]
View answerIn February 2012, H.E. Mr. CHEN Zhu, Minister of Health of the People's Republic of China extended an invitation to visit China to James Reilly, the then Minister for Health. Minister Reilly visited China from 13 to 19 August 2012.
A Memorandum of Understanding (MOU) on health co-operation between the Department of Health of Ireland and the Ministry of Health of the People's Republic of China was signed by both Ministers at a bilateral meeting on 16 August 2012. The Memorandum replaced a previous MOU which covered the period 2004 to 2009. The objective of the MOU is to encourage and develop cooperation and exchange in the field of healthcare between the two countries.
The areas of co-operation set out in the Memorandum 2012 - 2017 are:
1. Health regulation.
2. eHealth and telemedicine
3. Medical professional training
4. Health promotion
5. Maternal and child health
6. Hospital standards
7. Traditional Chinese medicine
In May 2013, Minister Reilly hosted a visit from Madam Li Bin (appointed Health Minister in March 2013) and a delegation of senior officials from China's National Health and Family Planning Commission (HHFPC). The programme included meetings with Minister Reilly and senior officials at which a range of health issues were discussed including health reform, public hospital management, primary health care, community health services and general practitioner training. Visits to a primary care centre and St. Vincent's Hospital, Dublin also took place. The visit afforded the opportunity to discuss issues of mutual interest and establish links between appropriate institutions. It also provided the delegation from China to witness and learn of examples of good practice in the health area.
I am aware that in September 2014 sixteen Chinese healthcare workers (GPs) and two Chinese officials were invited to Ireland by the Royal College of Surgeons (RCSI), the Irish College of General Practitioners (ICGP) and Heedo (accredited healthcare education online company) to visit a number of primary care centres in Dublin, Kildare and Cork and to attend a series of GP training workshops in key primary care teaching facilities.
The current MOU is valid until 2017.
132. Deputy Colm Keaveney asked the Minister for Health when a person (details supplied) in County Galway will receive a surgical procedure, in view of the fact that the person is waiting two years for the procedure; and if he will make a statement on the matter. [8435/15]
View answerThe National Waiting List Management Policy, A standardised approach to managing scheduled care treatment for in-patient, day case and planned procedures, January 2014, has been developed to ensure that all administrative, managerial and clinical staff follow an agreed national minimum standard for the management and administration of waiting lists for scheduled care. This policy, which has been adopted by the Health Service Executive, sets out the processes that hospitals are to implement to manage waiting lists.
In relation to the particular query raised, 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 my officials will follow the matter up with them.
133. Deputy Billy Kelleher asked the Minister for Health if he will increase funding to the Irish Osteoporosis Society; and if he will make a statement on the matter. [8439/15]
View answerAs 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. 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 met with the Irish Osteoporosis Society (IOS) on Monday 23 February 2015. This was a very constructive meeting and the IOS are now in communication with the HSE and the Department of Health.
134. Deputy Martin Heydon asked the Minister for Health if his Department has carried out any reviews, or has plans to review, the process of issuing of sick certificates, by general practitioners; the guidelines that are in place to determine the length of such sick certificates; and if he will make a statement on the matter. [8442/15]
View answerParagraph 11 of the 1989 General Medical Services (GMS) contract between the HSE and GPs stipulates that the duties of the GP under the contract include a requirement to furnish to a person whom he/she has examined and for whom he/she is obliged to provide services (or, in the case of a child, to his/her parent) a certificate in relation, to any illness noticed during the examination which is reasonably required by him/her or by the parent as the case may be. Such examinations as the doctor may carry out on a patient prior to the issue to him/her of first and final Social Welfare certificates are comprehended by the capitation payments. Payment under this contract is not made in respect of certain other certificates required, e.g. under the Social Welfare Acts or for the purposes of insurance or assurance policies or for the issue of driving licenses.
The Medical Council’s Guide to Professional Conduct and Ethics for Registered Medical Practitioners states that:
"In issuing certificates, reports, prescriptions and other formal documents, you must be accurate and make sure the document is legible. You must also include your Medical Council registration number. Normally you should only sign a certificate or other such prescription, report or document for a patient following review of the patient’s condition”.
I understand the Medical Council’s website advises the public and employers that all complaints received relating to this issue will be thoroughly investigated and action will be taken should a doctor be found to be in breach of the Guide.
135. Deputy Bernard J. Durkan asked the Minister for Health the extent to which primary care centres are capable of alleviating the burden of overcrowding at the accident and emergency facilities in general hospitals, by way of dealing with cases which may not require hospital treatment; and if he will make a statement on the matter. [8449/15]
View answerI assume the Deputy is referring to the extent to which Primary Care Centres helped to alleviate overcrowding in accident and emergency departments in their catchment areas in recent weeks. As this information relates to service issues and is not routinely provided to my Department, I have asked the Health Service Executive to reply directly to the Deputy on these matters. 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.
136. Deputy Bernard J. Durkan asked the Minister for Health if he remains satisfied regarding the availability of adequate nursing home beds in the public and private sector, with a view to the alleviation of overcrowding at accident and emergency in general hospitals; and if he will make a statement on the matter. [8450/15]
View answer137. Deputy Bernard J. Durkan asked the Minister for Health if he expects to make provision for peak requirements, in respect of step-down beds, in sufficient numbers to alleviate and strategically address the incidents of overcrowding, at accident and emergency facilities; and if he will make a statement on the matter. [8451/15]
View answerI propose to take Questions Nos. 136 and 137 together.
A substantial proportion of our acute beds are occupied by people who no longer require acute care. In order to meet this challenge a wide-ranging set of measures have been put in place. The Government provided additional funding of €3m last December and €25m in Budget 2015 to address delayed discharges. This funding is being targeted at hospital and community services to address specific needs of delayed discharge patients. The funding will support
- 300 extra people under the Nursing Home Support Scheme.
- 50 additional transitional care beds allocated to the Dublin Hospitals on a named patient basis which will be recycled to the hospitals when available.
- 65 beds to be brought on stream on a phased basis, during 2015 at Mount Carmel Hospital.
- 400 extra Home Care Packages to benefit 600 people in the course of the year.
- The expansion of the community intervention team services in primary care.
Increased levels of activity being experienced in acute hospitals since the beginning of January 2015, driven by presentations of older people with chronic disease and the ongoing high level of delayed discharge experienced by the hospitals have led to further measures being required. These include the funding of 900 transitional care beds in private nursing homes (500 in January, and a further 400 in February), as a short-term measure to assist in the discharge of patients from acute hospitals, and 173 short-stay public beds being opened across the country for a three month period.
138. Deputy Bernard J. Durkan asked the Minister for Health the extent to which he will be in position to put in place procedures to ensure that patients who do not qualify for medical cards on income grounds, may be re-evaluated, and their eligibility suitably weighted, to take account of a particular illness, terminal or otherwise, which may require extra ordinary care, cost, attention and stress to the particular families; and if he will make a statement on the matter. [8452/15]
View answerThe medical card system is fundamentally based on means and this position has obtained for more than 40 years. However, the Government recognises that the health service needs to be responsive to the circumstances of people with significant medical needs. In November 2014 the Minister for Health and I announced a series of measures to enhance the operation of the medical card scheme and make it more sensitive to people’s needs, especially where serious illness is involved. Where deemed appropriate in particular circumstances, the HSE may exercise discretion and grant a medical card even though an applicant's means exceed the prescribed threshold. Where a person does not qualify for a medical card, they may be provided with a GP Visit Card, appropriate therapy or other community supports or drugs and appliances under the Long Term Illness scheme, where the qualification criteria are met.
The medical card system is now operating in a more sensible and sensitive manner. Greater discretion is clearly being exercised by the HSE because the number of discretionary medical cards in circulation has increased by about 50% - from about 52,000 in mid-2014 to nearly 79,000 at the end of January this year.
The HSE has recently established a Clinical Advisory Group for Medical Card Eligibility. The Group will provide oversight and guidance to the operation of a more compassionate medical card system and will focus initially on the development of a framework for assessment and measurement of the burden of disease in this context.
139. Deputy Bernard J. Durkan asked the Minister for Health the degree to which adequate facilities remain available to meet the ongoing health care, and requirements, of the population, such as primary care facilities, and medical and surgical bed accommodation in the public sector, throughout the country; if he has identified areas needing improvement in this regard; and if he will make a statement on the matter. [8453/15]
View answerDespite constraints on our capital and revenue budgets in recent years, a very ambitious infrastructure programme is under way to support the provision of an enhanced and a more integrated range of health care services.
Details of the infrastructure to be completed in 2015 and which will become operational this year or in early 2016 are set out in Appendix 4 of the HSE’s National Service Plan 2015. Overall there are of the order of 80 projects detailed, of which approximately 40 relate to acute care services and the remainder to community care services including primary care.
Planned infrastructure developments to support acute facilities include the National Ambulance Control and Call Centre at Tallaght; the upgrade and replacement of equipment for BreastCheck; the new endoscopy unit at Roscommon General Hospital; the fit-out of the underground car-park at Limerick UH; expansion of the radiology department at Clonmel’s South Tipperary General Hospital; completion of the new ED, medical assessment unit and endoscopy unit at St Luke’s Kilkenny; additional cubicle space and resus accommodation at Tallaght ED and upgrade of its endoscopy unit. At Connolly Hospital, the radiology department upgrade is being completed and its urology department expanded. In addition, planning for the new Children’s Hospital and the relocation of the NMH to St Vincent’s University Hospital is progressing.
The HSE is also undertaking a substantial infrastructure project at Naas General Hospital. The project will be a two storey build. An oncology unit and a physical medicine department (which includes physiotherapy, occupational therapy and speech therapy) will be accommodated on the ground floor adjacent to the main concourse and out-patients. An endoscopy unit will be located on the first floor adjacent to the theatre department, which is the ideal location from a patient safety, logistics and staffing viewpoint.
The opening of the Ballinamore primary care centre earlier this month brings to 43 the number of primary care centres opened since March 2011. This represents considerable progress. Overall there are now 86 primary care centres operating across the country. There are also currently over 30 locations where primary care infrastructure is at an advanced planning stage and approximately 50 further locations where the HSE proposes to use the operational lease mechanism to deliver primary care infrastructure. In November 2014, the HSE advertised a further 73 locations for delivery by the operational lease mechanism; the closing date for expressions of interest was mid-January 2015.
In the light of recent Emergency Department pressures the HSE has postponed most elective care, apart from cancer and urgent cases, whilst opening all bed stock to the maximum extent possible to allow those who need immediate treatment to be accommodated. Hospital bed requirements generally will be further considered by hospital groups in their strategic plans, which are due to be developed this year as part of the implementation of the groups. Changing clinical practice requirements and the closer integration of community and hospitals services which, it is anticipated, will see more care and treatment delivered in community settings in the future, will be taken into account in these plans.
140. Deputy Bernard J. Durkan asked the Minister for Health the extent to which the practice over the past number of years has altered, resulting in a greater number of referrals to accident and emergency; the way this may be addressed in the short and medium term; and if he will make a statement on the matter. [8454/15]
View answerAs 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 my officials will follow the matter up with them.
141. Deputy Bernard J. Durkan asked the Minister for Health the extent of facilities, expected to be made available normally, at primary care centres; and if he will make a statement on the matter. [8455/15]
View answerThe HSE has responsibility for the provision of Primary Care Centres and the provision of facilities at such centres. Therefore, this 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.
142. Deputy Bernard J. Durkan asked the Minister for Health the total number of primary care centres currently operational throughout the country; the number and location of those yet to be provided, or in course of construction; and if he will make a statement on the matter. [8456/15]
View answerTo date, there are 86 Primary Care Centres in operation throughout the country, 43 of which have opened since 2011.
There are currently 37 locations where Primary Care Centres are at an advanced planning stage using one of the following three methods of delivery:
- Direct build (by HSE);
- Public Private Partnership (PPP) project; or
- Operational Lease with the private sector.
I have asked the HSE to respond directly to the Deputy in regard to the locations. 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.
143. Deputy Bernard J. Durkan asked the Minister for Health the extent to which the rules applicable in the Single Market will benefit the procurement of drugs in this country; and if he will make a statement on the matter. [8457/15]
View answerDecisions on pricing and reimbursement of pharmaceutical products within public health systems are a national competence for EU Member States. However, the issue of pricing and reimbursement of medicines has been the subject of recent discussion at an EU level.
The Council of the European Union issued conclusions in December 2014 on the issue of innovation for the benefit of patients which included the issue of co-operation on the pricing of medicines between Member States. The Council conclusions invited the European Commission and Member States to examine opportunities for potential co-operation on a voluntary basis in the field of pricing and reimbursement.
I have indicated previously in discussions at an EU level on this issue that I am supportive of proposals that would deliver greater transparency in prices. However, I am mindful that this may be difficult to achieve as Member States negotiate directly with pharmaceutical companies to agree commercially confidential discounts on the price of medicines and to establish patient access schemes.
A number of mechanisms exist at a European level to assist with the issue of pricing and reimbursement of medicines. In 2008 the network of Competent Authorities on Pricing and Reimbursement was created of which Ireland is a member. This is an informal platform which discusses the issues and challenges in the field of pricing and reimbursement of medicines. Ireland also has access to the EU Euripid Database which was launched in 2010. This is a web based database which provides up to date information on the prices of medicines which can be accessed by participating Member States.
It is also worth noting that a Joint Procurement Agreement for medical countermeasures is in place at an EU level which enables countries, including Ireland, to procure pandemic vaccines and other medical countermeasures on a group rather than individual basis.
144. Deputy Bernard J. Durkan asked the Minister for Health the extent to which he expects orthodontic services to be prioritised in the short and medium term, having particular regard to the number of children diagnosed as being in need of such services; and if he will make a statement on the matter. [8458/15]
View answerThe HSE provides orthodontic treatment to those who have been assessed and referred for treatment before their 16th birthday. It should be noted that the nature of orthodontic care means that immediate treatment is not always desirable. It is estimated that in up to 5% of cases it is necessary to wait for further growth to take place before treatment commences. Patients are assessed by the HSE Orthodontic Service under the modified Index of Treatment Need. Patients with the greatest level of need, i.e. Grade 5 or some with a Grade 4 are provided with treatment by the HSE.
The HSE has established a pilot scheme in Dublin North East which will involve the use of orthodontic therapists in the treatment of a number of eligible children. In addition to the services provided by HSE staff, orthodontic treatment for certain categories of misalignment will be provided by a panel of independent practitioners under contract to the HSE over the next three years. A national procurement process is being finalised. This initiative will especially focus on those waiting for 4 years or longer. It is expected that this initiative will have a positive impact on waiting times.
145. Deputy Bernard J. Durkan asked the Minister for Health the extent to which medical, nursing or consultant posts remain to be filled throughout the public health services; and if he will make a statement on the matter. [8459/15]
View answerThe Minister for Public Expenditure and Reform announced in budget 2014 that he intended to delegate greater autonomy to Departments and Agencies to manage their own staffing levels. The change from the application of a rigid employment control framework to one operating strictly within allocated pay frameworks allows for recruitment where it is determined that this can achieve more economical service delivery.
The HSE is currently focused on reducing nursing agency expenditure through the appointment of full time staff. The HSE plans to increase the substantive General Nursing Workforce establishment by 550 in real terms during 2015 - from 30,500 to 31,050. It also plans to increase the substantive Mental Health Nursing Workforce establishment by 372 in real terms during 2015 - from 4,447 to 4,819. The HSE National Recruitment Service is pursuing the recruitment of nurses as a priority.
I expect the new pay scales for new entrant consultants agreed between Management and the IMO at the LRC on 7th January 2015 will help us to keep more of our medical graduates at home and persuade consultants who are working overseas to return to Ireland. I want this new package to send a strong message to Irish medical graduates that pay and also working conditions are improving again and that they can be part of the health recovery in Ireland. The recruitment of additional consultants is a priority and arrangements are in train to recruit consultants. A joint HSE/Public Service Appointment project team has been appointed to progress the recruitment process for consultants.
I have asked the HSE to respond to the Deputy directly on the specific details sought. 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.
146. Deputy Bernard J. Durkan asked the Minister for Health the degree to which the number of medical, surgical or step-down hospital beds has fluctuated, in each of the past ten years, to date; and if he will make a statement on the matter. [8460/15]
View answerAs 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 my officials will follow the matter up with them.
147. Deputy Bernard J. Durkan asked the Minister for Health if he will standardise and speed up medical card appeals; and if he will make a statement on the matter. [8461/15]
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.
If the Deputy has not received a reply from the HSE within 15 working days, please contact my Private Office who will follow up the matter with them.
148. Deputy Bernard J. Durkan asked the Minister for Health the position regarding the implementation of the next stage of development at Naas General Hospital, Naas, County Kildare; and if he will make a statement on the matter. [8462/15]
View answerThe HSE is developing a substantial infrastructure project at Naas General Hospital which includes an endoscopy unit. The proposed project will be a two storey build. The oncology unit and the physical medicine department which includes physiotherapy, occupational therapy and speech therapy will be accommodated on the ground floor adjacent to the main concourse and out-patients. The endoscopy unit will be located on the next floor overhead and at the same level as, and adjacent to, the theatre department which is the ideal location from a patient safety, logistics and staffing viewpoint.
While some enabling works are required to the hospital infrastructure, (electrical distribution system, etc) and subject to the award of planning permission it is expected that project construction could commence in the second half of 2015.
This is a considerable infrastructure investment in Naas General Hospital and in service delivery for Kildare.
149. Deputy Bernard J. Durkan asked the Minister for Health the position regarding the provision of primary care centres in County Kildare, those already constructed and operational, and those planned, and when they are likely to become available; and if he will make a statement on the matter. [8463/15]
View answerThe HSE has responsibility for the provision, maintenance and operation of Primary Care Centres. Therefore, this 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.
150. Deputy Finian McGrath asked the Minister for Health regarding the cross-border healthcare directive, if the Health Service Executive will pay a health care provider in another member state directly, as opposed to the patient paying the costs up-front, and claiming reimbursement following treatment, as this excludes many persons, and only persons of means are in a position to avail of cross-border treatment, and this goes against the spirit of the directive; and if he will make a statement on the matter. [8465/15]
View answerThe EU Directive on Patients’ Rights in Cross-Border Healthcare (Directive 2011/24) provides rules for the reimbursement to patients of the cost of receiving treatment abroad, where the patient would be entitled to such treatment in their home Member State and supplements the rights that patients already have under EU Regulation 883/04 on the co-ordination of social security schemes. The Directive seeks to ensure a clear and transparent framework for the provision of cross-border healthcare within the EU, for those occasions where the healthcare patients seek is provided in a Member State other than their home Member State.
The European Union (Application of Patients’ Rights in Cross-Border Healthcare) Regulations 2014 were signed on 14 May, 2014 and came into operation on 1 June 2014. This Statutory Instrument implements key provisions of the Directive, namely, providing for reimbursement by the HSE of qualifying cross-border healthcare, a system of prior authorisation, and the placing of the National Contact Point (NCP) on a Statutory basis.
The Cross-Border Healthcare Directive permits patients to choose their healthcare provider in the EU but does not require a Member State to pay for that care directly. The avenue that is available to patients seeking to have their treatment abroad authorised and paid for directly by the HSE is under the HSE's Treatment Abroad Scheme which operates under the rules set by Regulation 883/04.
