Thursday, 1 Dec 2016

Written Answers Nos. 234 - 246

General Practitioner Services Provision

Questions (234)

Michael Healy-Rae

Question:

234. Deputy Michael Healy-Rae asked the Minister for Health his views on a matter (details supplied) regarding retirements; and if he will make a statement on the matter. [38154/16]

Written answers

Minister for Health

As 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.

Medicinal Products Reimbursement

Questions (235)

Michael Healy-Rae

Question:

235. Deputy Michael Healy-Rae asked the Minister for Health his views on a matter (details supplied) regarding Respreeza; and if he will make a statement on the matter. [38155/16]

Written answers

Minister for Health

The 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.

In reaching its decision, the HSE examines all the evidence which may be relevant in its view for the decision (including the information/dossier submitted by the Company) and will take into account such expert opinions and recommendations which may have been sought by the HSE at its sole discretion (for example, from the National Centre for Pharmacoeconomics).

In considering an application, the HSE will also have regard to Part 1 and Part 3 of Schedule 3 of the 2013 Act. Part 3 requires the HSE to have regard to the following criteria:

1. the health needs of the public;

2. the cost-effectiveness of meeting health needs by supplying the item concerned rather than providing other health services;

3. the availability and suitability of items for supply or reimbursement;

4. the proposed costs, benefits and risks of the item or listed item relative to therapeutically similar items or listed items provided in other health service settings and the level of certainty in relation to the evidence of those costs, benefits and risks;

5. the potential or actual budget impact of the item or listed item;

6. the clinical need for the item or listed item;

7. the appropriate level of clinical supervision required in relation to the item to ensure patient safety;

8. the efficacy (performance in trial), effectiveness (performance in real situations) and added therapeutic benefit against existing standards of treatment (how much better it treats a condition than existing therapies); and

9. the resources available to the HSE.

I am informed that the HSE received a request and economic dossier from the manufacturer of Respreeza for maintenance treatment of emphysema in adults with documented severe alpha1-proteinase inhibitor deficiency.

In June of this year the HSE asked the NCPE to carry out a health technology assessment on the cost effectiveness of this treatment. This assessment is still on-going. Once the assessment is completed, a summary report will be published on the NCPE website.

The HSE will then consider the NCPE assessment, and other expert advice, as part of its decision-making process for reimbursement. This decision will be made on objective, scientific and economic grounds by the HSE in line with the 2013 Act.

In relation to compassionate access schemes, I have previously asked manufacturers to show compassion and to maintain access to compassionate access schemes for patients during the assessment process by the HSE and this remains the position. However, the operation of compassionate access schemes is at the discretion of manufacturers.

Mental Health Services Data

Questions (236)

James Browne

Question:

236. Deputy James Browne asked the Minister for Health the numbers waiting for a child and adolescent mental health service appointment in each local health office area in tabular form; and the numbers waiting up to three months, three to six months, six to nine months, nine to 12 months and more than 12 months. [38156/16]

Written answers

Minister of State at the Department of Health

As this is a service issue, this question has been referred to the HSE for direct reply.

Speech and Language Therapy

Questions (237)

Michael Healy-Rae

Question:

237. Deputy Michael Healy-Rae asked the Minister for Health his views on a matter (details supplied) regarding employment opportunities; and if he will make a statement on the matter. [38157/16]

Written answers

Minister for Health

As this is a service issue, this question has been referred to the HSE for direct reply.

Question No. 238 answered with Question No. 233.

Medical Card Applications

Questions (239)

Bernard Durkan

Question:

239. Deputy Bernard J. Durkan asked the Minister for Health when a medical card will be awarded in the case of a person (details supplied); and if he will make a statement on the matter. [38209/16]

Written answers

Minister for Health

The 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 was issued to Oireachtas members.

Hospital Waiting Lists

Questions (240)

Bernard Durkan

Question:

240. Deputy Bernard J. Durkan asked the Minister for Health the degree to which waiting times can be reduced for elective procedures in hospitals; and if he will make a statement on the matter. [38212/16]

Written answers

Minister for Health

This Government is committed to improving waiting times for patients. While recognising that demand for acute hospital services has increased this year with a 4% increase in inpatient and day case activity to end October compared with the same period last year, the important issue for patients is how long they wait.

The targets set out in the HSE Service Plan 2016 indicated that 95% of people should be waiting less than 15 months for their inpatient or daycase appointment. The latest figures published by the NTPF indicate that approximately 11 % of patients are waiting over 15 months for an inpatient or daycase appointment.

In August, I asked the HSE to develop a Waiting List Action Plan for 2016 to reduce by year end the number of patients waiting over 18 months on the Inpatient Daycase Waiting List. Since then, approximately 6,500 patients have been removed from the Waiting List. Further, approximately €11m of Winter Initiative funding has been allocated in order to support patient treatment under this Action Plan.

Budget 2017 provides for the treatment of our longest-waiting patients. €20m is being allocated to the National Treatment Purchase Fund (NTPF) in 2017, rising to €55m in 2018. Planning of these initiatives is currently being finalised with the NTPF. I will shortly be asking the HSE to develop a Waiting List Action Plan for 2017 working collaboratively with the NTPF to address inpatient, daycase and outpatient waiting times.

Emergency Departments

Questions (241)

Bernard Durkan

Question:

241. Deputy Bernard J. Durkan asked the Minister for Health the steps he continues to take to alleviate the problem of overcrowding at various general hospitals here; and if he will make a statement on the matter. [38213/16]

Written answers

Minister for Health

Trolley numbers nationally have been high in November due to increased ED attendances, greater incidence of infection in several hospitals and a high rate of elective activity in hospitals to address waiting lists.

It is unacceptable that patients wait on trolleys for long periods especially elderly and vulnerable patients. Over the coming months it is essential that the health service plans effectively for expected surges in emergency care demand. My Department, working with the HSE, has been driving a range of measures to improve patient ED experience times.

Following the formation of Government an additional €40 million was provided to assist in the management of winter pressures. Utilising this additional funding the HSE developed the Winter Initiative Plan 2016 – 2017 which was published in September. Key aspects of this plan are being implemented at hospital and community services level across the country.

Today the HSE convened a Winter Initiative Health Summit and I met with Hospital Group CEOs, as well as hospital and Community Health Organisation managers, to reinforce the importance of driving key performance improvements across primary, acute and social care to reduce ED overcrowding and to plan for expected surges in demand in our EDs in the New Year.

I can assure the Deputy that there is a very strong focus on reducing ED overcrowding in all my interactions with the HSE, hospitals and the wider health service.

Medical Card Administration

Questions (242, 243)

Bernard Durkan

Question:

242. Deputy Bernard J. Durkan asked the Minister for Health his plans to further streamline the medical card application process to ensure that children with disabilities are provided with the required support; and if he will make a statement on the matter. [38214/16]

Bernard Durkan

Question:

243. Deputy Bernard J. Durkan asked the Minister for Health if the processing of medical card applications can be expedited; and if he will make a statement on the matter. [38215/16]

Written answers

Minister for Health

I propose to take Questions Nos. 242 and 243 together.

Under the Health Act, 1970, 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 dependents and every application must be assessed on that basis. In accordance with the Act, the assessment for a medical card is determined primarily by reference to the means, including the income and expenditure, of the applicant and his or her partner and dependents. Where deemed appropriate in particular circumstances, the HSE may exercise discretion and grant a medical card even though an applicant exceeds the income guidelines but where they may face difficult financial circumstances, such as extra costs arising from illness.

It should be noted that every effort is made by the HSE, within the framework of the legislation, to support applicants in applying for a medical card and, in particular, to take full account of the difficult circumstances in the case of applicants who may be in excess of the income guidelines.

Social and medical issues are considered when determining whether undue hardship exists for an individual accessing general practitioner or other medical services. The HSE affords applicants the opportunity to furnish supporting information and documentation to fully take account of all the relevant circumstances that may benefit them in the assessment, including medical evidence of cost and necessary expenses.

It is important that people with medical needs and it is important that they should be able to access necessary assistance in a straight forward manner. It is clear greater discretion is being exercised by the HSE because the number of discretionary medical cards in circulation has increased from about 52,000 in mid-2014 to over 113,200 as of 1st November this year.

Furthermore, I have recently received permission from Government for my Department to prepare the Heads and General Scheme of a Bill to give children in receipt of DCA automatic entitlement to a medical card. This new legislation will effectively mean that all children in respect of whom a DCA payment is made will automatically qualify for a medical card and, therefore, no longer be subject to the medical cards means test at any point in the future while in receipt of DCA. It is my objective to have this legislation prepared and brought before the Oireachtas as quickly as possible. In addition to the preparation of the legislation, I have asked the HSE, so that the proposal can be implemented in a smooth and efficient manner, to commence the process of planning for the requirements of the scheme and how the cards will issue.

Primary Care Centres Data

Questions (244)

Bernard Durkan

Question:

244. Deputy Bernard J. Durkan asked the Minister for Health the number of primary care centres currently fully staffed and operational; the extent to which evidence exists of the alleviation of overcrowding in hospital accident and emergency departments as a result; and if he will make a statement on the matter. [38216/16]

Written answers

Minister for Health

As the Deputy will be aware, the Programme for a Partnership Government commits to a decisive shift towards primary care so that we can provide better care close to home for communities around the country. Primary Care Centres facilitate the shift from acute care towards primary care through the range of multi-disciplinary services they can provide and the role they can play in keeping people who don't need to be in an acute setting out of hospital. There are 97 Primary Care Centres now in operation, 40 centres are in construction or at advanced planning stage. A further 43 locations are at preliminary stages of development.

There is a range of initiatives and services provided in a primary care setting and which I hope to see further developed, which are intended to prevent unnecessary hospital admission or attendance and to facilitate early discharge of patients. These initiatives include the implementation of Community Intervention Teams (CITs), Outpatient Parenteral Antimicrobial Therapy (OPAT), Ultrasound Diagnostics and the GP Minor Surgery Pilot Initiative.

With 13 CIT teams in place, there have been over 22,667 referrals from January to October of this year which have reduced hospital bed requirements by approximately 76 beds per day. Referrals to CITs from Emergency Departments and hospital wards have increased by 58.4% in 2016 compared to the same period last year. Referrals from GPs to CITs have increased by 31.9% over the same period.

A project to increase access to diagnostic services in GP surgeries is currently delivering approximately 1,500 ultrasounds per month, while the GP Minor Surgery pilot has delivered just over 4,200 procedures since commencement. Also, usage of out-of-hours GP services from January to September 2016 has increased by 11%, compared to the same period last year.

The 2016/2017 Winter Initiative provides for the expansion of Community Intervention Team services in four areas (Dublin North, Louth/Meath, Galway/Roscommon and South Tipperary) with potential to support more than 6,500 additional patients through the winter and during 2017.

As the provision of Primary Care Centres and related staffing and service matters are the responsibility of the Health Service Executive (HSE), I have arranged for the question to be referred to the HSE for direct reply to the Deputy.

Medical Card Data

Questions (245)

Bernard Durkan

Question:

245. Deputy Bernard J. Durkan asked the Minister for Health the total number of persons who currently hold a medical card; the number of such cards that have been withdrawn and-or updated in each of the past three years to date; and if he will make a statement on the matter. [38217/16]

Written answers

Minister for Health

As this question relates to service matters, I have arranged for the question to be referred to the Health Service Executive (HSE) for direct reply to you.

Medicinal Products Prices

Questions (246)

Bernard Durkan

Question:

246. Deputy Bernard J. Durkan asked the Minister for Health the procedures in place to encourage manufacturers of medicines to make their product available for sale to the health services at a manageable cost with particular reference to top-of-the-range new products with an expensive price tag; and if he will make a statement on the matter. [38218/16]

Written answers

Minister for Health

The recently signed 2016 Framework Agreement on the Supply and Pricing of Medicines provides for a new and more robust process for the reimbursement of medicines offering greater certainty to manufacturers regarding the reimbursement process.

The revised process now requires that each product seeking reimbursement under the Community Drugs Schemes will undergo an assessment process by the National Centre for Pharmacoeconomics (NCPE). As part of this process the manufacturer must submit the price at which it is seeking reimbursement for its product. Under Clause 6.2.1 of the Framework Agreement the maximum supplier proposed price shall be no greater than the average of the currency-adjusted relevant price (being the ex- factory price or equivalent thereof and using the applicable Exchange Rate) applicable in such of the Nominated States in which the Medicine is available on the date of application. Under Clause 6.2.3 medicines are also subject to an annual price realignment so as to ensure that prices in Ireland fall in line with prices in other basket countries.

Once submitted to the NCPE the product will then be assessed in terms of its safety, clinical effectiveness and cost-effectiveness at the price submitted. The cost-effectiveness of the drug at the price submitted is factored into the NCPE's recommendation on whether or not the product should be reimbursed.

Following a recommendation from the NCPE the HSE enters into negotiations with manufacturers often seeking price reductions. The HSE frequently seeks to address what it may regard as excessive pricing demands around new medicines so as to bring those medicines within the range of affordability.

It is important to point out however that the HSE does not select the prices of patented medicines, that is determined by the pharmaceutical industry. Therefore I would urge all pharmaceutical companies to submit pricing proposals which are affordable and sustainable and which represent value for money for the Irish health service, patients and the taxpayer.