Written Answers Nos. 230-244
230. Deputy Pat Deering asked the Minister for Health further to Question No. 391 of 18 October 2016, when the HSE will respond to the person in view of the letters that have been provided stating the person requires urgent medical attention. [34153/16]
View answerThe Deputy's previous question was referred to HSE for response. I understand that the HSE has been in direct contact with the Deputy's office seeking further detail, including the name of the relevant hospital, before a response can be provided.
231. Deputy John McGuinness asked the Minister for Health the action he will take in support of persons with Lyme disease; his views on a television documentary screened recently and if he will address all of the issues raised; his views on a submission made by a support group (details supplied); if his attention has been drawn to the fact that over 40 new persons joined the support group immediately following the television documentary, indicating the large number of persons affected by Lyme disease; and if he will make a statement on the matter. [34192/16]
View answerLyme disease (also known as Lyme borreliosis) is an infection transmitted to humans by bites from ticks infected with the bacterium Borrelia burgdorferi. The infection is generally mild affecting only the skin, but can occasionally be more severe and debilitating. Many infected people have no symptoms at all. The commonest noticeable evidence of infection is a rash called erythema migrans that is seen in about 80 to 90% of patients. This red, raised skin rash (often called a bulls-eye rash) develops between 3 days and a month after a tick bite and spreads outwards from the initial bite site. People can also complain of 'flu-like symptoms such as headache, sore throat, neck stiffness, fever, muscle aches and general fatigue. Occasionally, there may be more serious symptoms involving the nervous system, joints, the heart or other tissues. Lyme Disease is the commonest cause of tick-borne infection in Europe.
Lyme borreliosis is a notifiable infectious disease, the notifiable entity being the more severe neurological form, Lyme neuroborreliosis. The Health Protection Surveillance Centre (HPSC) collects and collates surveillance data on the condition. The Weekly Infectious Disease Report, published by the HPSC on 26 October 2016, indicated that for week 42-2016 (16/10/16-22/10/16) there have been 16 cases notified so far in 2016 – an increase of 5 on the same period last year. However, the diverse and unspecific nature of the symptoms means that a number of the less serious cases may not be diagnosed, leading to an underreporting of cases. Recent estimates suggest that there may be up to 50-100 cases in Ireland per year.
Lyme disease can be very successfully treated using common antibiotics. These antibiotics are effective at clearing the rash and helping to prevent the development of complications. Antibiotics are generally given for up to three weeks. If complications develop, intravenous antibiotics may be considered. In Ireland, treatment by most clinicians is based on that laid out in evidence-based guidelines for the management of patients with Lyme disease, human granulocytic anaplasmosis (formerly known as human granulocytic ehrlichiosis), and babesiosis published by the Infectious Diseases Society of America (IDSA) in 2006. This pharmacological regime can be summarised thus:
- Doxycycline, amoxicillin or cefuroxime for the treatment of adults with early localized or early disseminated Lyme disease associated with erythema migrans, in the absence of specific neurologic manifestations (ceftriaxone in early Lyme disease for adults with acute neurologic disease manifested by meningitis or radiculopathy);
- Doxycycline, amoxicillin, or cefuroxime for adults with Lyme arthritis but without clinical evidence of neurologic disease;
- For late neurological disease in adults - intravenous ceftriaxone, cefotaxime or Penicillin G.
The Scientific Advisory Committee of the HPSC has established a Lyme Borreliosis Sub-Committee, the aim of which is to develop strategies to undertake primary prevention in order to minimise the harm caused by Lyme Borreliosis in Ireland. In addition to staff from the HPSC, the membership of the Sub-Committee includes specialists in Public Health Medicine, Consultants in Infectious Diseases, Clinical Microbiology, Occupational Health an Entomologist from the Parks and Wildlife Service, a representative from the Local Government Management Agency and an Environmental Health Officer. representation has also been sought from a Lyme Disease advocacy group.
The Terms of Reference of the Sub-Committee are:
- To raise awareness in Ireland of Lyme Borreliosis amongst clinicians and the general public;
- To identify and highlight best international practice in raising awareness about Lyme Borreliosis for the general public;
- To develop policies of primary prevention of Lyme Borreliosis in Ireland based on best international practice;
- To explore ways in which to improve surveillance of neuroborreliosis in Ireland;
- To develop strategies to raise awareness among the general public particularly in areas of higher tick populations;
- To produce a Final Report covering all the above areas.
The initial work of the Lyme Borreliosis Sub-committee involves a survey of laboratory methods for the diagnosis of Lyme borreliosis in Ireland, the development of Lyme borreliosis guidance for general practitioners, the publication of medical media articles to highlight diagnostics and laboratory methods relating to Lyme borreliosis available in Ireland for general practitioners, and ongoing work in drawing together the Final Report of the Sub-committee.The Sub-Committee is expected to report in 2017.
232. Deputy John McGuinness asked the Minister for Health if an early date for a hip operation will be arranged at Waterford Regional Hospital in respect of a person (details supplied); and if he will make a statement on the matter. [34193/16]
View answerUnder the Health Act 2004, the Health Service Executive (HSE) is required to manage and deliver, or arrange to be delivered on its behalf, health and personal social services. Section 6 of the HSE Governance Act 2013 bars the Minister for Health from directing the HSE to provide a treatment or a personal service to any individual or to confer eligibility on any individual.
The 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 HSE, 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.
233. Deputy John McGuinness asked the Minister for Health if the children services at a centre (details supplied) are to be discontinued from March 2017 or if another agency will take over the delivery of services, including residential services; if staff levels at this centre will be maintained; and if he will make a statement on the matter. [34195/16]
View answerThe Government is committed to providing services and supports for people with disabilities which will empower them to live independent lives, provide greater independence in accessing the services they choose, and enhance their ability to tailor the supports required to meet their needs and plan their lives. This commitment is outlined in the Programme for Partnership Government, which is guided by two principles: equality of opportunity and improving the quality of life for people with disabilities.
As the Deputy's question relates to an individual case, I have arranged for the question to be referred to the Health Service Executive (HSE) for direct reply to the Deputy.
234. Deputy Clare Daly asked the Minister for Health his views on the fact that the Rotunda Hospital is currently 42 midwives short of the recommended number of WTEs of 207.99, the National Maternity Hospital is 25 midwives short of its recommended complement of 234 and the Coombe Women and Infants University Hospital is 34 midwives short of its recommended complement of 212; the steps he will take to address these serious shortages; and if he will make a statement on the matter. [34198/16]
View answerIn May, the HSE granted approval to the Hospital Groups to recruit an additional 100 midwives. The allocation of these midwives was informed by the findings of the Birth Rate Plus midwifery workforce project.
In relation to the specific query raised, as this is a service matter, I have asked the HSE to respond to you directly.
235. Deputy Maureen O'Sullivan asked the Minister for Health when proton beam therapy will be available in hospitals here; and if he will make a statement on the matter. [34199/16]
View answerLast year 22 patients were referred for proton beam therapy in treatment centres abroad under the Treatment Abroad Scheme. This represents an extremely small proportion of Irish patients who are receiving radiotherapy.
The infrastructure and equipment required for proton beam therapy is hugely expensive and provision of such a facility in Ireland for the number of patients involved is not practical at this time.
The National Cancer Control Programme will continue to monitor the number of Irish patients being referred overseas for proton beam therapy, as well as developments in technology that may impact on the economic viability of this treatment.
236. Deputy Danny Healy-Rae asked the Minister for Health the reason the care homes caring for elderly priests are not subject to regulation by HIQA; and if he will make a statement on the matter. [34200/16]
View answerAt present HIQA's remit does not extend to the regulation of residential centres catering for elderly members of religious orders. Under Section 2 of the Health (Nursing Homes) Act 1990, premises in which the majority of the persons being maintained are members of a religious order or priests of any religion are offered an exemption to registration. This is a matter that I will keep under review.
237. Deputy Jack Chambers asked the Minister for Health the number of medical cards issued per month over the past ten years in tabular form; and if he will make a statement on the matter. [34206/16]
View answer238. Deputy Jack Chambers asked the Minister for Health the number of general practitioner visit cards issued per month over the past ten years in tabular form; and if he will make a statement on the matter. [34207/16]
View answerI propose to take Questions Nos. 237 and 238 together.
The Health Service Executive has been asked to examine these matters 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 was issued to Oireachtas members.
239. Deputy Jack Chambers asked the Minister for Health the number of persons currently awaiting placement under the fair deal scheme for each local health area in tabular form; and the waiting time [34208/16]
View answerAs this is a service matter it has been referred to the Health Service Executive for direct reply.
240. Deputy Jack Chambers asked the Minister for Health his views on the considerable concerns of the private and voluntary nursing home sector regarding the failings of the fair deal funding model and the push for greater equality in fees payable for the provision of nursing home care; and if he will make a statement on the matter. [34209/16]
View answerThe legislation underpinning the Nursing Homes Support Scheme requires each private nursing home to negotiate and agree a price for long-term residential care services with the National Treatment Purchase Fund (NTPF) should they wish to be an approved nursing home for the purposes of the Scheme. The NTPF has statutory independence in the performance of its function, and negotiates with each nursing home on an individual basis. The NTPF may examine the records and accounts of nursing homes as part of the process with the objective of setting a fair price which delivers value for money to the individual and the State. In negotiating with nursing homes, the NTPF has regard to:
- Costs reasonably and prudently incurred by the nursing home and evidence of value for money;
- Price(s) previously charged;
- Local market price; and
- Budgetary constraints and the obligation on the State to use available resources in the most beneficial, effective and efficient manner to improve, promote and protect the health and welfare of the public.
The Review of the Nursing Homes Support Scheme, which was published in July 2015, committed to a review of pricing mechanisms by the NTPF, with a view to:
- Ensuring value for money and economy, with the lowest possible administrative costs for clients and the State and administrative burden for providers;
- Increasing the transparency of the pricing mechanism so that existing and potential investors can make as informed decisions as possible; and
- Ensuring that there is adequate residential capacity for those residents with more complex needs.
Work has been under way on this Review for a number of months now and it is expected to be completed in the coming months.
The HSE has recently published the cost of care for all public nursing homes. There are a number of reasons why the costs of public facilities are generally higher than those in the private sector, including a higher nurse staffing ratio and the impact of public service rates of pay and conditions of employment.
The geographical spread of residential placements is also a factor. In some rural areas long stay beds are provided for geographical reasons in smaller centres which would not be profitable for a private provider to supply, e.g. Achill Island and Donegal.
With that said, it is important that public facilities operate as efficiently and economically as possible and deliver the best possible value for money. Towards that end the HSE is already engaged in a comprehensive exercise to review and streamline the operation and cost structures of public facilities. Differences in the comparative cost of public and private long-term residential care will also be the subject of a Value for Money and Policy Review to be undertaken by the Department of Health in 2017 to assess reasons for and components of current cost differentials.
241. Deputy Joe Carey asked the Minister for Health if he will re-enter negotiations with a company (details supplied), the manufacturer of the cystic fibrosis drug Orkambi, with a view to reaching an agreement and enabling persons with cystic fibrosis here to access the recognised health benefits from its use; and if he will make a statement on the matter. [34210/16]
View answerThe HSE has statutory responsibility for decisions on pricing and reimbursement of medicines under the community drugs schemes, in accordance with the Health (Pricing and Supply of Medical Goods) Act 2013.
These decisions are made on objective, scientific and economic grounds by the HSE. In reaching its decision, the HSE examines all the evidence which may be relevant in its view for the decision and will take into account such expert opinions and recommendations which may have been sought by the HSE, including, for example, advice from the National Centre for Pharmacoeconomics.
I am informed that, following a request from the HSE, the NCPE carried out an assessment of the manufacturer's economic dossier submitted in March 2016 on the cost effectiveness of lumacaftor/ivacaftor (Orkambi). This dossier included details on all relevant costs and relevant cost offsets including hospitalisation, disease management costs, intravenous antibiotics, adverse events and any additional costs arising in patients not taking Orkambi.
The NCPE has completed its HTA and submitted it to the HSE in June 2016. The NCPE determined, following an evaluation of the economic dossier, that the manufacturer failed to demonstrate cost-effectiveness or value for money from using the drug. The NCPE have confirmed that all relevant costs were included in the analysis. A summary of the HTA has been published on the NCPE website and is available at: http://www.ncpe.ie/wp-content/uploads/2015/12/Website-summary-orkambi.pdf.
The HSE has since had further engagements with the manufacturer in an effort to secure significant price reductions for Orkambi. This process is ongoing The HSE will consider the outcome of these engagements and any other, together with the NCPE recommendation, in making a final decision on reimbursement.
242. Deputy Michael Healy-Rae asked the Minister for Health the status of an operation in respect of a person (details supplied); and if he will make a statement on the matter. [34212/16]
View answerUnder the Health Act 2004, the Health Service Executive (HSE) is required to manage and deliver, or arrange to be delivered on its behalf, health and personal social services. Section 6 of the HSE Governance Act 2013 bars the Minister for Health from directing the HSE to provide a treatment or a personal service to any individual or to confer eligibility on any individual.
The 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 HSE, 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.
243. Deputy Michael Healy-Rae asked the Minister for Health the status of a hospital appointment in respect of a person (details supplied); and if he will make a statement on the matter. [34213/16]
View answerUnder the Health Act 2004, the Health Service Executive (HSE) is required to manage and deliver, or arrange to be delivered on its behalf, health and personal social services. Section 6 of the HSE Governance Act 2013 bars the Minister for Health from directing the HSE to provide a treatment or a personal service to any individual or to confer eligibility on any individual.
The scheduling of appointments for patients is a matter for the hospital to which the patient has been referred. Should a patient's general practitioner consider that the patient's condition warrants an earlier appointment, he or she should take the matter up with the consultant and the hospital involved. In relation to the specific case raised, I have asked the HSE to respond to you directly.
244. Deputy Pat Deering asked the Minister for Health when an appointment in respect of a person (details supplied) will be rescheduled. [34214/16]
View answerAs this is a service matter it has been referred to the HSE for reply to the Deputy.
