Eamon Scanlon
Question:8. Deputy Eamon Scanlon asked the Minister for Health the increase in home help hours the Sligo-Leitrim local health area can expect in 2017. [38029/16]
View answerHome Help Service Provision
Questions (8)
Written answers
I am pleased to say that overall funding for services for older people has increased to €765 million in 2017 - an increase of €82 million since the HSE’s 2016 Service Plan. This has focused on additional funding for homecare in particular and is aimed at allowing people to continue to live in their own homes and at facilitating discharge of older people from acute hospitals.
The HSE Service Plan 2016 originally provided for 10.4 million hours and 15,450 Home Care Packages. These targets were revised to 10.57 million hours and 16,450 packages as a result of the additional funding announced under the revised Estimates, which included resources for this year’s Winter Initiative. The expected level of activity provided in the 2016 Plan for Sligo, Leitrim and West Cavan is 425,000 home help hours and 345 Packages.
In a situation where demand continues to grow, challenges remain in managing home care budgets. However, the increased resources provide additional flexibility to managers who are responsible for meeting these challenges in each geographic area within the resources available.
The level of health services to be provided next year will be set out in the HSE’s 2017 National Service Plan, which is expected to be finalised shortly.
Questions Nos. 9 to 12, inclusive, answered orally.
Palliative Care for Children
Questions (13)
Thomas Pringle
Question:13. Deputy Thomas Pringle asked the Minister for Health his plans to provide respite for families of children with life-limiting conditions in County Donegal as existing home care help does not facilitate the respite needs for those families; and if he will make a statement on the matter. [37897/16]
View answerWritten answers
The Palliative Care For Children with Life-Limiting Conditions in Ireland - A National Policy, was published by my Department in March 2010.
A programme of care for children with life-limiting conditions has been established including the appointment of a Paediatric Consultant with a Special Interest in Palliative Care, based in Crumlin. As well as supporting other paediatricians, the Consultant also provides clinical support and advice to maternity hospitals and neonatologists. The programme also included the appointment of eight Children’s Outreach Nurses whose role is to ensure that children being cared for at home by their families have access to co-ordinated and supportive services. The nurses liaise closely with statutory and voluntary service providers including local GPs, Public Health Nurses, Disability Services, the Jack and Jill Foundation and LauraLynn. A further two Children's Outreach Nurses are being recruited under the Programme, one in Letterkenny and the other to the Children's Hospital Group.
The Letterkenny post will be advertised in the coming weeks and will be entitled Clinical Nurse Co-ordinator for Children with Life-limiting Conditions. This nurse will work closely with the existing Paediatric Liaison Nurse based in Donegal and will provide a service to children and families in Donegal as well as acting as an informed resource for colleagues in Sligo.
The HSE is currently considering how both in-home and in-patient respite services might be made more available for children in Donegal and surrounding areas. All possibilities will be considered, including through cross-border co-operation or collaboration with relevant voluntary groups.
Question No. 14 answered orally.
Hospital Waiting Lists
Questions (15)
John Lahart
Question:15. Deputy John Lahart asked the Minister for Health the reason for the 137% increase in inpatient and day case waiting lists in Temple Street Children’s Hospital since April 2014, significantly ahead of the national average increase of 57%. [38038/16]
View answerWritten answers
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.
Under the HSE Service Plan 2016 targets, 95% of people should be waiting less than 15 months for their inpatient or daycase appointment. The latest NTPF inpatient/daycase waiting list figures show that 99% of patients at Temple Street are waiting less than 15 months for their inpatient/daycase appointment and 94% of patients are waiting less than 12 months.
There are a number of factors contributing to the hospital's waiting list including the appointment of additional consultants resulting in additional demand on theatre and an increase in the number of referrals from across the country. There has been a 6.2% increase in in-patient activity in Temple Street over the last two years. The HSE has advised that the waiting list is proactively managed to ensure that patients who clinically require admission are prioritised and then patients are admitted in chronological order.
Budget 2017 provides for the treatment of our longest-waiting patients. €20m is being allocated to the NTPF in 2017, rising to €55m in 2018. I met the Chair and CEO of the NTPF last Tuesday and I have granted approval to their proposal which outlines the use of a first tranche of funding, in the region of €5m, for an initiative focusing on daycase procedures. The NTPF and HSE are currently engaging regarding a proposal for the use of the remaining funding for patient treatment in 2017. This gradual, stepped approach will enable the NTPF to build new operational capacity towards its 2018 allocation.
In addition, it is intended that the NTPF's proposal will free up capacity in the public hospital system to provide treatment to those patients awaiting inpatient treatment, whose requirements are more complex and thus more suited to the public hospital system.
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, including at Temple Street Children's Hospital.
Home Help Service Provision
Questions (16)
Jim O'Callaghan
Question:16. Deputy Jim O'Callaghan asked the Minister for Health the increase in home help hours planned for the Dublin south east and Dún Laoghaire local health areas in 2017. [38052/16]
View answerWritten answers
I am pleased to say that overall funding for services for older people has increased to €765 million in 2017 - an increase of €82 million since the HSE’s 2016 Service Plan. This has focused on additional funding for homecare in particular and is aimed at allowing people to continue to live in their own homes and at facilitating discharge of older people from acute hospitals.
The HSE Service Plan 2016 originally provided for 10.4 million hours and 15,450 Home Care Packages. These targets were revised to 10.57 million hours and 16,450 packages as a result of the additional funding announced under the revised Estimates, which included resources for this year’s Winter Initiative.
In a situation where demand continues to grow, challenges remain in managing home care budgets. However, the increased resources provide additional flexibility to managers who are responsible for meeting these challenges in each geographic area within the resources available.
The level of health services to be provided next year, including homecare targets, will be set out in the HSE’s 2017 National Service Plan, which is expected to be finalised shortly.
Emergency Departments
Questions (17)
Jackie Cahill
Question:17. Deputy Jackie Cahill asked the Minister for Health the reason for the substantial increase in emergency department overcrowding in South Tipperary General Hospital over the past two years. [38047/16]
View answerWritten answers
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.
South Tipperary General Hospital is one of nine hospitals which have been targeted in this year’s Winter Initiative. In order to alleviate ED overcrowding at the hospital, a range of specific measures have been put in place. These include the expansion of access to Community Intervention Teams services to support the hospital by facilitating hospital avoidance and timely discharge. Additional homecare packages are also being provided; from 3 October to the 5 February, an additional 3 homecare packages per week will be provided in the Sth Tipperary area. Additional access to aids and appliances to support timely discharge will also be provided. A tender process to establish a National Framework Agreement for Temporary Accommodation is currently being evaluated. Based on the outcome of this process, the HSE will consider options, to provide additional capacity at the hospital.
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.
Medicinal Products Reimbursement
Questions (18)
Joan Collins
Question:18. Deputy Joan Collins asked the Minister for Health the status of the negotiations between the HSE, Health Service Executive, and NCPE, National Centre for Pharmacoeconomics, and a pharmaceutical company (details supplied) regarding Orkambi for cystic fibrosis, in view of the fact it is 24 weeks since the original decision was made not to recommend Orkambi based on cost; and if he will make a statement on the matter. [37780/16]
View answerWritten answers
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.
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 Orkambi. This dossier included details on all relevant costs and relevant cost offsets including those associated with hospitalisation, disease management costs, intravenous antibiotics, adverse events and any additional costs arising in patients not taking Orkambi.
The NCPE has completed its Health Technology Assessment and this is available on its website. It was submitted 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.
The HSE has recently completed its most recent round of negotiations with the manufacturer. On foot of this, the HSE’s Drugs Committee, having considered the NCPE recommendation and other expert advice, is in the process of sending its latest recommendation on the cost-effectiveness of Orkambi to the HSE Directorate. The HSE Directorate will then make a decision taking into consideration the manufacturers latest price offer. This decision will be made on objective, scientific and economic grounds in line with the 2013 Act.
I share the HSE's disappointment that the manufacturer in this case has maintained a very high price in the course of negotiations in relation to the potential reimbursement of Orkambi for Irish patients.
I appreciate that this is a very stressful time for Cystic Fibrosis patients and their families. However, I want to assure them that I do not consider this to be the end of the process. I would strongly urge Vertex, as the manufacturer in this case, to fundamentally reconsider its position and to table a pricing proposal which can facilitate the provision of Orkambi at a price that will represent value for money for the Irish health service, patients and the taxpayer.
I would also like to inform the Deputy that I have written to the Health Ministers in England, Scotland, Canada and Australia asking them to collaborate to try and make progress on accessing Orkambi at a cost effective price for cystic fibrosis patients in each of their countries.
Hospital Waiting Lists
Questions (19)
Pat Casey
Question:19. Deputy Pat Casey asked the Minister for Health the reason more than 6,000 children were waiting over a year for an outpatient consultation in the children’s hospital group in October 2016; and if he will make a statement on the matter. [38044/16]
View answerWritten answers
This Government is committed to improving waiting times for patients. While recognising that demand for acute hospital services has increased, the important issue for patients is how long they wait.
Under the HSE Service Plan 2016 targets, 85% of people should wait less than 52 weeks for their first outpatient appointment. The latest NTPF Outpatient Waiting List figures indicate that 81% of patients in the Children's Hospital Group are waiting less than 52 weeks for their first outpatient appointment. 94% of patients are waiting less than 18 months for access to outpatient services.
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 for an inpatient or daycase procedure. Since then, approximately 6,500 patients have been removed from the waiting list nationally.
Regarding outpatient waiting lists in particular, the HSE recently launched the Strategy for the design of Integrated Outpatient Services 2016-2020. It seeks to improve waiting times for outpatient services by enhancing patient referral pathways and utilising technology to enable better planning.
Budget 2017 provides for the treatment of our longest-waiting patients. €20m is being allocated to the NTPF in 2017, rising to €55m in 2018. Planning of these initiatives is currently being finalised. 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 also outpatient waiting times including in the Children's Hospital Group.
Emergency Departments
Questions (20)
Niall Collins
Question:20. Deputy Niall Collins asked the Minister for Health the reason for the substantial increase in emergency department overcrowding in University Hospital Limerick over the past two years. [38051/16]
View answerWritten answers
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.
With regard to University Hospital Limerick, the Deputy may wish to note that a new state of the art Emergency Department, which will triple the size of the current Department, is scheduled to open in 2017.
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.
Occupational Therapy
Questions (21)
Brendan Smith
Question:21. Deputy Brendan Smith asked the Minister for Health the action being taken to address the fact that latest figures indicate some 230 persons under 18 years of age are waiting more than a year for a first-time assessment for occupational therapy in counties Cavan and Monaghan. [38031/16]
View answerWritten answers
The Programme for a Partnership Government commits to a decisive shift within the health service towards primary care in order to deliver better care close to home in communities across the country. Occupational Therapy has, as one of its core values, the principle of enabling people to remain in their own homes and communities.
A National Service Improvement Group has been established to review Occupational Therapy waiting times and the Primary Care Division is working with the Chief Officers in each area to address waiting lists. This group is chaired by a Chief Officer. I am confident that the review will have a positive impact on the future delivery of Occupational Therapy services throughout the country.
In relation to treatment waiting lists, the majority of clients once they are assessed move straight to treatment and therefore an additional waiting time does not arise. I am advised by the HSE that Occupational Therapists are addressing high-risk Priority 1 cases including a large number of children's Assessments of Needs cases, which are a legal entitlement. Priority 1 cases also include those with urgent equipment needs to address high safety needs thereby reducing risks to children and their families, and children at high risk of placement breakdown. The Priority 2 waiting list is addressed based on the availability of resources and the HSE endeavours to provide the highest quality of services within available resources.
As of September 2016, the HSE directly employs 1,168 (WTE) Occupational Therapists, which is an increase of 40 WTE since December 2015.
Primary Care Strategy
Questions (22)
John Brassil
Question:22. Deputy John Brassil asked the Minister for Health if he has a target spend for primary care as a share of the health budget between now and 2021; the way in which Ireland’s expenditure on primary care compares to other OECD countries; and if he will make a statement on the matter. [38022/16]
View answerWritten answers
The Programme for a Partnership Government commits to a decisive shift within the health service towards primary care in order to deliver better care close to home in communities across the country. The Programme emphasises the need and focus on enhancing primary health care services including the building up of GP capacity, increasing the number of therapists and other health professionals in primary care and continuing to expand the development of primary care facilities/centres.
Looking beyond 2017, I have consistently said that I strongly believe that the health service would benefit enormously from a single unifying vision that we can all get behind and that can help to drive reform and development of the system over the next 10 years. The Programme for a Partnership Government committed to the establishment of an Oireachtas All-Party committee to develop a long term vision for healthcare and direction of health policy over a 10 year period, with cross party support. The Committee on the Future of Healthcare was established in June this year and has set its objectives including to achieve cross-party consensus on a ten year vision for the health service with an emphasis on quality of patient care, supported by strong managerial and organisational accountability and also to develop a model of integrated healthcare with an emphasis on primary and community care.
Budget 2017 delivered the highest health budget ever at €14.6 billion. The level of health services to be provided within the available funding will be set out in the HSE’s 2017 National Service Plan, which is currently being finalised. Of the HSE 2016 budget for the Health Services, the proportion assigned to primary care in 2016 is 28% and I anticipate a comparable apportioning in 2017.
The OECD does not provide a cross-country analysis for spending on primary health care services, as the definition of primary care varies from country to country. However, Eurostat publishes relevant statistical information at European level. For the year 2014 it has published data for twenty-two of the EU 28 Member States- no such data is available from Denmark, Italy, Malta, the UK, Romania or Slovenia. From this data the best available approximation for total expenditure on primary care (private and public spending) can be created by combining expenditure on ambulatory health care providers and pharmacies. Based on this data, Ireland is ranked 8th of the 22 Member States for per capita expenditure on ambulatory health care and pharmacies, adjusted for Purchasing Power Standards.
Palliative Care Services Provision
Questions (23)
Robert Troy
Question:23. Deputy Robert Troy asked the Minister for Health the detail of the HSE plans in place to support north Westmeath hospice and palliative care in the county generally; and if he will make a statement on the matter. [38060/16]
View answerWritten answers
Significant progress has been made in recent years in improving access to specialist palliative care services. At present 93% of people receive specialist palliative care services in the community within seven days of referral while 96% have access to a specialist bed within seven days. Specialist palliative care is now provided in 11 locations countrywide, and the number of specialist palliative care beds will reach 217 once all 15 beds in Kerry Hospice are open.
The successful development of palliative care services in Ireland has been based on a long standing tradition of positive engagement between the voluntary and statutory sector. Organisations such as the North Westmeath Hospice play a vital role in this work by collaborating in a very positive way on a range of fronts to strengthen the provision of palliative care.
With funding provided through the North Westmeath Hospice a position of Social Worker in Westmeath is due to filled in January 2017. This is in addition to a consultant post for the Midlands which is currently being processed through recruitment and due to be in place in early 2017. These posts are a welcome development and will make a real difference for clients in North Westmeath.
The HSE will continue to engage with the North Westmeath Hospice Group, as with similar Groups elsewhere, to further develop all levels of palliative services generally in the County.
Emergency Departments
Questions (24)
Seán Fleming
Question:24. Deputy Sean Fleming asked the Minister for Health the reason for the substantial increase in emergency department overcrowding in the Midland Regional Hospital, Portlaoise, over the past two years. [38037/16]
View answerWritten answers
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. The HSE has confirmed that there has been a 2% increase in attendances at the ED in Portlaoise since 2015.
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. Portlaoise Hospital has developed a Winter Capacity Plan to assist in managing the demand for services over the winter period. Measures include additional consultant hours assigned to the ED, appointment of a second advance nurse practitioner for ED and appointment of a bed manager. These appointments will assist in ensuring optimal use of available beds, timely patient flow and an improved patient experience for minor injuries.
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.
Home Help Service Provision
Questions (25, 26, 61, 71, 81, 96, 101)
Brendan Smith
Question:25. Deputy Brendan Smith asked the Minister for Health the increase in home help hours the Cavan-Monaghan local health area can expect in 2017. [38030/16]
View answer
Seán Haughey
Question:26. Deputy Seán Haughey asked the Minister for Health the increase in home help hours the Dublin north central local health area can expect in 2017. [38041/16]
View answer
Bobby Aylward
Question:61. Deputy Bobby Aylward asked the Minister for Health the increase in home help hours the Carlow-Kilkenny local health area can expect in 2017. [38035/16]
View answerPat Casey
Question:71. Deputy Pat Casey asked the Minister for Health the increase in home help hours Wicklow local health area can expect in 2017. [38045/16]
View answer
James Lawless
Question:81. Deputy James Lawless asked the Minister for Health the increase in home help hours Kildare local area can expect in 2017. [38048/16]
View answerJackie Cahill
Question:96. Deputy Jackie Cahill asked the Minister for Health the increase in home help hours Tipperary local health area can expect in 2017. [38046/16]
View answerNiall Collins
Question:101. Deputy Niall Collins asked the Minister for Health the increase in home help hours the County Limerick local health area can expect in 2017. [38050/16]
View answerWritten answers
I propose to take Questions Nos. 25, 26, 61, 71, 81, 96 and 101 together.
I am pleased to say that overall funding for services for older people has increased to €765 million in 2017 - an increase of €82 million since the HSE’s 2016 Service Plan. This has focused on additional funding for homecare in particular and is aimed at allowing people to continue to live in their own homes and at facilitating discharge of older people from acute hospitals.
The HSE Service Plan 2016 originally provided for 10.4 million hours and 15,450 Home Care Packages. These targets were revised to 10.57 million hours and 16,450 packages as a result of the additional funding announced under the revised Estimates, which included resources for this year’s Winter Initiative.
In a situation where demand continues to grow, challenges remain in managing home care budgets. However, the increased resources provide additional flexibility to managers who are responsible for meeting these challenges in each geographic area within the resources available.
The level of health services to be provided next year, including homecare targets, will be set out in the HSE’s 2017 National Service Plan, which is expected to be finalised shortly.
HSE National Service Plan
Questions (27)
Billy Kelleher
Question:27. Deputy Billy Kelleher asked the Minister for Health when the HSE service plan for 2017 will be published; and if he will make a statement on the matter. [38012/16]
View answerWritten answers
The HSE National Service Plan 2017 which sets out the type and volume of health and personal social services that the HSE undertakes to provide within its financial allocation was formally submitted for my approval on Friday 25th November, 2016. Under the Health Act 2004 (as amended), I have 21 days from receiving the plan to either:
a) approve the service plan in the form it was submitted
b) approve the service plan with such amendments as I, having consulted with the Executive may determine, or
c) issue a direction to the Executive to amend the Plan.
Once the Plan has been approved, it must be laid before both Houses of the Oireachtas within 21 days and afterwards must be published by the HSE as soon as practicable.
Assisted Human Reproduction Services Provision
Questions (28)
Eoin Ó Broin
Question:28. Deputy Eoin Ó Broin asked the Minister for Health the status of the review of international public funding models for fertility treatment; if he has received the Health Research Board review of international public funding models for fertility treatment; when he will receive and publish it in view of the fact it is due before the end of 2016; when the general scheme of legislative provisions dealing with assisted human reproduction, AHR, will be published; the timeframe for the legislation dealing with AHR; and if he will make a statement on the matter. [37858/16]
View answerWritten answers
In February of this year, the then Minister for Health announced his intention to provide public funding for assisted human reproduction (AHR) treatment in conjunction with the planned introduction of legislation in this area. In order to determine the most appropriate funding model for AHR in the State, the Health Research Board (HRB) was engaged to conduct a comprehensive review of international public funding models. This HRB evidence review is due to be completed before the end of 2016. The HRB evidence review will then be analysed by officials in my Department in terms of considering policy options for a potential public funding model for AHR treatment. It is envisaged that the final evidence review will be published both on my Department’s website and on the HRB’s own website in 2017.
Officials in my Department are currently drafting the General Scheme of legislative provisions on AHR and associated research, and it is envisaged that it will be completed in 2017. This comprehensive piece of legislation will regulate a range of practices for the first time, including: gamete (sperm or egg) and embryo donation for AHR and research; surrogacy; pre-implantation genetic diagnosis (PGD) of embryos; posthumous assisted reproduction; and stem cell research. Once the General Scheme has been completed, and has been approved by Government, it will be submitted to the Joint Oireachtas Committee on Health and Children for pre-legislative scrutiny.
It is not possible to give a definitive time frame for the completion of the Bill and its subsequent passage through the Houses of the Oireachtas.
Occupational Therapy
Questions (29)
Aindrias Moynihan
Question:29. Deputy Aindrias Moynihan asked the Minister for Health the action being taken to address the fact that latest figures indicate some 1,049 persons under 18 years of age are waiting more than a year for a first-time assessment for occupational therapy in counties Cork and Kerry. [38032/16]
View answerWritten answers
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 the Deputy.
Services for People with Disabilities
Questions (30)
Gino Kenny
Question:30. Deputy Gino Kenny asked the Minister for Health the urgent respite that can be offered to such carers and the long-term remedy he is considering in view of the reply to parents of disabled adults that there is a ten-year waiting list for residential care and that the HSE is unable to provide them with an average waiting time, or indicate when a bed may be available; and if he will make a statement on the matter. [37964/16]
View answerWritten answers
The 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 service matters, I have arranged for the question to be referred to the Health Service Executive (HSE) for direct reply to the Deputy, for any further information that they may be able to provide.
Medicinal Products Prices
Questions (31)
John Brady
Question:31. Deputy John Brady asked the Minister for Health the number of drugs where, following the National Centre for Pharmacoeconomics, NCPE, assessment of the manufacturer's economic dossier on the cost-effectiveness of a drug, including 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 a drug, the NCPE found a drug not to be cost-effective; if he will provide this information for each of the past five years with a breakdown of whether additional price reductions were successfully negotiated and agreed upon; and if he will make a statement on the matter. [37860/16]
View answerWritten answers
As this is a service matter it has been referred to the HSE for reply to the Deputy.
Rare Diseases Strategy
Questions (32)
Paul Murphy
Question:32. Deputy Paul Murphy asked the Minister for Health his plans to increase the number of genetic counsellors as outlined in the national rare disease plan; and if he will make a statement on the matter. [37770/16]
View answerWritten answers
A National Rare Disease Plan was published in 2014 and it contains 48 recommendations covering areas such as research, establishment of a national clinical programme and a national office for rare diseases, and the identification of Centres of Expertise. The report did not make a recommendation on increasing the number of genetic counsellors but rather that there is appropriate access to pre-conception genetic testing and counselling and that National Centres of Expertise be identified in accordance with European Union criteria for the care of patients with rare diseases.
One of the principal recommendations in the Plan was the establishment of a National Clinical Programme for Rare Diseases. This programme was to be responsible, over time and among other functions, to assist with developing care pathways for rare diseases and facilitating timely access to centres of expertise.
In line with this recommendation, a National Clinical Programme for Rare Diseases was established in 2013 under the National Clinical Strategy and Programmes Division of the HSE. The programme is a joint initiative between the HSE and the Royal College of Physicians of Ireland. This clinical programme is a channel for assisting with the advancement of a number of other recommendations in the plan, such as those on National Centres of Expertise for rare diseases; and in this vein, the programme designed a framework for the designation of Irish Centres of Expertise in cooperation with HSE Acute Hospitals Division in line with the recommendations stipulated in the national plan.
The National Clinical Programme for Rare Diseases and the Department of Health encouraged designated Centres of Expertise to participate in European Reference Networks (ERNs) for Rare Diseases in line with the national plan. ERNs are European networks connecting health care providers and centres of expertise so that international expertise on specific rare diseases may be pooled together for the benefit of patients. Any centre applying for membership of an ERN must have strategies in place to ensure that care is patient-centred; that patients' rights and preferences are respected; and must show a research component to their work.
Hence, the recommendations in the national plan that relate to empowering and protecting patients and carers, including treatment will be fulfilled in part through this process. It is expected that ERNs will have a major structuring effect by linking thematic expert centres across the EU.
With the encouragement of the National Clinical Programme for Rare Diseases, Acute Hospital Divisions in the HSE and the Department of Health, five centres of expertise were designated in June this year during the first round of calls from the European Commission for participation in European Reference Networks. Three of these designated centres applied for membership of ERNs. It is anticipated that the National Centre for Medical Genetics will have a role in these European Reference Networks in due course.
The establishment of a National Rare Disease Office (NRDO) featured prominently in the recommendations of the Rare Disease plan. The national office was established by the HSE in June 2015. Its work is currently led by the NCPRD Clinical Lead, supported by an Information Scientist, part-time Administrative Officer, part-time Genetic Counsellor and by a 0.2FTE Consultant Geneticist. It is, among other functions, providing up-to-date information regarding new treatment and management options, including clinical trials. In addition, the post of Information Scientist for the office is being funded jointly by the HSE and the EU Commission.
Palliative Care Services
Questions (33)
Bríd Smith
Question:33. Deputy Bríd Smith asked the Minister for Health if his attention has been drawn to the refusal to grant funding for the redevelopment of the palliative care unit in Our Lady's Hospice and Care Unit in Harold's Cross, Dublin 6; and if he will make a statement on the matter. [37961/16]
View answerWritten answers
As this is a service matter it has been referred to the Health Service Executive for direct reply.
Medicinal Products Reimbursement
Questions (34)
Thomas P. Broughan
Question:34. Deputy Thomas P. Broughan asked the Minister for Health if his attention has been drawn to the struggles faced by persons suffering from the rare metabolic condition phenylketonuria, PKU, in accessing suitable very low protein food and protein substitute food products; his plans to address this issue and improve the range of such products available to persons on the long-term illness card list and generally available here; and if he will make a statement on the matter. [37777/16]
View answerWritten answers
The HSE has statutory responsibility for decisions on pricing and reimbursement of products under the community drug schemes, including the LTI Scheme, in accordance with the provisions of the Health (Pricing and Supply of Medical Goods) Act 2013; therefore, the matter has been referred to the HSE for reply to the Deputy.
Services for People with Disabilities
Questions (35)
Thomas P. Broughan
Question:35. Deputy Thomas P. Broughan asked the Minister for Health the measures he is taking to address the deficits in the legislative powers given to the HSE in the 2007 Health Act in protecting vulnerable adults in different settings as outlined by the chief executive of HIQA recently; and if he will make a statement on the matter. [37946/16]
View answerWritten answers
A National Safeguarding Committee was established in December 2015 with the overarching remit to support the development of a societal and organisational culture which promotes the rights of persons who may be vulnerable and safeguard them from abuse. It is a multi-agency and inter-sectoral body with an independent chair and will publish its Strategic Plan 2017 – 2021 on 20 December 2016. This plan includes the strategic objective of informing and influencing Government policy and legislation to safeguard the rights of people who may be vulnerable, including a focus on issues such as adult safeguarding, advocacy, the use of chemical restraint and deprivation of liberty.
The Health Service Executive has operational responsibility for planning, managing and delivering home and other community-based services for older people and people with a disability. However, as highlighted recently by the HIQA CEO, homecare services are currently not formally regulated. It is accepted that there is a need to regulate the sector but a significant amount of preparatory work is required in advance of this. The Department has asked the Health Research Board to review how homecare services are funded and regulated in comparable jurisdictions. The HRB review is expected to be completed by the end of 2016.
On the Mental Health side, following the publication last year of the Expert Group Review of the Mental Health Act, Government has approved plans to significantly improve and update mental health legislation which primarily deals with admission to and treatment in psychiatric hospitals of adults and children diagnosed with mental illness. Work has begun on amending this legislation guided by the recommendations of the Review. A draft bill is expected in mid-2017.
Prescriptions Data
Questions (36)
Gino Kenny
Question:36. Deputy Gino Kenny asked the Minister for Health his views on the monitoring of trends in the prescription of psychoactive psychotropic drugs here, especially to children, over the past 20 years; if his attention has been drawn to concerns regarding the rise in problems associated with prescribed medications, especially opioid painkillers and benzodiazepine sedatives in terms of drug dependency and overdose, including fatal overdose; the measures being taken to address the rise in prescription rates and associated problems regarding prescription medications; and if he will make a statement on the matter. [37968/16]
View answerWritten answers
My Department is aware of reports on trends indicating the increased use of psychotropic drugs. We are also aware that in recent years the nature and scale of drug misuse has changed, with an increased prevalence of poly-drug use, as well as use of benzodiazepines, and other prescription or non-prescription medications. Treatment figures indicate an increase in the number of people seeking treatment for benzodiazepine use.
The fourth national drug prevalence survey, carried out in 2014/15, examined the use of psychotropics such as sedatives and tranquillisers (which include benzodiazepines) in the adult population aged 15 or over; 14% of those surveyed reported having used such drugs at some point in their lives. The number of drug-related deaths is one of the key indicators used to measure the consequences of problem drug use. The number of deaths where benzodiazepines were implicated increased by 24%, to 160 in 2013 compared with 129 in 2012. Two fifths of poisonings in 2013 involved benzodiazepines.
The drugs prevalence survey also found that more than 6 in 10 (61.5%) Irish people report having used “other opiates” at some stage in their life. However these reports do not include information on the source of these drugs; whether they have been prescribed for them or sourced illicitly.
The Medical Council is the statutory body for the registration and regulation of doctors engaged in medical practice. The Council has set out specific requirements for doctors regarding prescribing of drugs at section 42 of its Guide to Professional Conduct and Ethics for Registered Medical Practitioners (2016). While the Guide is not a legal code, it sets out the principles of professional practice and conduct that all doctors registered with the Medical Council are expected to follow. At 42.3 it states that when prescribing medications, doctors must comply with Misuse of Drugs legislation and other relevant regulations and/or guidelines. Whilst at 42.7 the Guide advises that doctors must be aware of the dangers of drug dependency when prescribing benzodiazepines, opiates and other drugs with addictive potential.
In 2013 the Irish College of General Practitioners published guidance for its members on diagnosing and managing mental health difficulties in children and adolescents. In June of this year the Early Warning Emerging Trends (EWET) subcommittee of the National Advisory Committee on Drugs and Alcohol, with the agreement of my Department, wrote to health care professionals highlighting the need for vigilance when prescribing and dispensing pregabalin and gabapentin, as these drugs present a risk of addiction and a potential for illegal diversion and misuse. Prescribers were advised to always undertake a risk benefit assessment prior to prescribing either of these medicines for patients under their care.
Specifically in relation to benzodiazepines there are prescribing guidelines in place at national level for both general practitioners (GPs) and psychiatrists. The Good Prescribing Practice for Clinicians guidelines were published in 2002 to guide GPs about prescribing benzodiazepines. Standards of practice should ensure short term use of benzodiazepines, using the lowest dose possible and, where their use has been for longer than four weeks, clear evidence of education on reducing with a view to discontinuing. If this is not possible there should be clear documentation on reasons for continuing the prescription.
The College of Psychiatry issued a Consensus Statement on the Use of Benzodiazepines in Specialist Mental Health Services in 2012. The College recommends that members who prescribe benzodiazepines should follow good practice guidelines for their use. This includes conducting regular audit of practice.
The HSE has written to all GPs outlining their levels of benzodiazepine and other hypnotics prescribing on the GMS scheme in an initiative to encourage better quality prescribing of these drugs. This was in line with a recommendation from my Department’s 2002 Report of the Benzodiazepine Committee. GPs received individualised and confidential reports every three months. The reports, compiled from PCRS data on the number of benzodiazepine and hypnotics prescriptions dispensed by pharmacists, allowed GPs to see exactly how many times they have prescribed these drugs in the preceding months. Most benzodiazepines and the so-called “z-drug” zolpidem are already controlled under the Misuse of Drugs Acts. Regulations and Orders made under the Misuse of Drugs Acts specify the level of control which apply to these substances.
The Misuse of Drugs (Amendment) Act 2016 was passed by the Oireachtas in July. Stricter controls will apply to certain psychotropic drugs including phenazepam, lisdexamphetamine, zopiclone and zaleplon. Controlling these substances in the Act was part one of a two-step process. The Act provides for the revocation and remaking of various Regulations and Orders which had been confirmed by the Misuse of Drugs (Amendment) Act 2015.
Work on drafting various new Regulations and Orders is complex and technical in nature but is at an advanced stage and is expected to be completed in the coming weeks. Among other things, these new Regulations will introduce stricter prescribing and dispensing rules on a number of psychotropic drugs including benzodiazepines and z drugs.
Hospital Beds Data
Questions (37)
Dessie Ellis
Question:37. Deputy Dessie Ellis asked the Minister for Health the reason the number of available inpatient beds has reduced from 12,051 in 2006 to 10,473 in 2015 and 10,629 in 2016 to date; the number of psychiatry and long-term care beds that have been excluded since 2006 to show only acute beds in the 2015 and 2016 figures; the factors that determine the reason an inpatient bed in 2006 is no longer available in 2015 and 2016; if the physical infrastructure still exists for these beds; if so, the details of same; and if he will make a statement on the matter. [37864/16]
View answerWritten answers
As this is a service issue, this question has been referred to the HSE for direct reply.
National Treatment Purchase Fund
Questions (38)
Dessie Ellis
Question:38. Deputy Dessie Ellis asked the Minister for Health further to the budget announcement of additional funding being made to the NTPF, the evaluation mechanisms that are in place to ensure value for money in terms of the spend; the evaluation mechanisms that are in place to ensure satisfactory outcomes and number of treatments in accordance with the funding allocation; and if he will make a statement on the matter. [37863/16]
View answerWritten answers
Budget 2017 provides for the treatment of our longest waiting patients. €20m is being allocated to the NTPF, rising to €55m in 2018.
On foot of this allocation the NTPF recently issued a Prior Information Notice stating that commissioning will recommence and they will be engaging with suppliers through competitive dialogue on the required optimum approach for future outsourcing of public patients. Controls to ensure quality patient treatment, value for money and efficient processes will be determined by this process.