Written Answers Nos. 52 - 64
52. Deputy John Brady asked the Minister for Health the number of treatments commissioned from the private sector by the National Treatment Purchase Fund, NTPF, in each year since its inception in tabular form; the number of treatments commissioned from the private sector by his Department or the HSE in each of the past ten years if applicable; and if he will make a statement on the matter. [37859/16]
View answerTreatments have been commissioned from the private sector by both the National Treatment Purchase Fund (NTPF) and the HSE in targeted initiatives to reduce waiting list numbers.
The NTPF was established on a statutory basis in 2004 and previously arranged for the provision of hospital treatment to classes of persons determined by the Minister. Since 2011 this function has been suspended.
I include with the official report a tabular statement setting out details of the annual budget of the NTPF and the number of patients treated per annum since its inception.
Budget 2017 provides for the treatment of our longest-waiting patients. €20m is being allocated to the NTPF, rising to €55m in 2018. Planning for these initiatives is currently being finalised with the NTPF. As part of this process, I have requested that the NTPF put in place a robust monitoring and evaluation process of the outputs and outcomes to ensure that the learning gleaned informs future initiatives.
In relation to treatments commissioned from the private sector by the HSE, as this is a service matter I have asked the HSE to respond to you directly.
53. Deputy Gerry Adams asked the Minister for Health the status of the HSE negotiations with the pharmaceutical company responsible for the production of the cystic fibrosis drug Kalydeco in respect of the effort to secure significant price reductions for the drug; when the process is due to conclude; and if he will make a statement on the matter. [37868/16]
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.
In line with the 2013 Act, if a Company would like a medicine to be reimbursed by the HSE pursuant to the Community Drug Schemes or as a hospital medicine, the Company must first submit an application to the HSE to have the new medicine added to the Reimbursement List or to be priced as a hospital medicine. The Company must submit a separate application to extend a treatment to a new cohort of patients. Each application is considered separately on its merits and in line with the 2013 Act.
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 Ivacaftor, brand name Kalydeco, for the treatment of cystic fibrosis patients aged 2 years and older weighing less than 25kg. In March of this year the HSE asked the NCPE to carry out a health technology assessment of the applicant’s economic dossier on the cost effectiveness of this treatment.
The NCPE completed its assessment and made a recommendation in October 2016. The NCPE determined that the manufacturer failed to demonstrate cost-effectiveness of the drug for its intended cohort of patients and did not recommend that it should be reimbursed for this indication at the submitted price. In the economic dossier submitted to the NCPE the manufacturer estimates that there are 18 patients eligible for early ivacaftor treatment.
A summary of the health technology assessment has been published on the NCPE website and is available at: www.ncpe.ie/wp-content/uploads/2015/12/Ivacaftor-2-5-years-web-summary.pdf .
As the HSE is responsible for the negotiations with manufacturers I have asked them to reply to the Deputy directly in relation to the status of negotiations with the manufacturer.
I understand how patients and their families must feel in these circumstances as they await the decisions by the HSE in relation to reimbursement. However as with all new drugs developed, the HSE must follow a process, as set out in the 2013 Act.
54. Deputy Charlie McConalogue asked the Minister for Health if the Saolta group has developed a urology strategy for the north west in particular to ensure that there is a consultant urologist for Letterkenny University Hospital; and if he will make a statement on the matter. [37776/16]
View answer88. Deputy Charlie McConalogue asked the Minister for Health his plans to appoint a consultant urologist for Letterkenny University Hospital; and if he will make a statement on the matter. [37775/16]
View answerI propose to take Questions Nos. 54 and 88 together.
During 2017, the Hospital Groups will be developing strategic plans for the development of services in their region. As part of its Strategic Plan, the Saolta University Healthcare Group will develop its strategy for urology services.
The Saolta Group envisages that it will operate a hub and spoke urology service model with a sub-hub in the North West.
This sub-hub will provide the majority of urology care locally, as a component of a Group-wide department. This will facilitate rapid access to the cancer centre in Galway for operative cancer care, with longer term local follow-up and surveillance. This will require additional urologists based in the Northwest, with strong links to the Model 4 hospital in Galway.
Following the retirement of the Letterkenny University Hospital Consultant Urologist in March 2015, a visiting Urologist from University Hospital Galway provides out-patient urology services, while a part-time locum provides in-patient and elective day surgery cover. The Saolta Group plans to recruit an Advanced Nurse Practitioner for Letterkenny University Hospital to support the delivery of urology services at the Hospital.
55. Deputy Thomas Pringle asked the Minister for Health when the neuro rehabilitation policy will be implemented including the development of inpatient rehabilitation services, the establishment of community neuro rehabilitation teams and long-term investment in rehabilitation specific services in communities; and if he will make a statement on the matter. [37896/16]
View answerThe Programme for Partnership Government includes a commitment to publish "a plan for advancing neuro-rehabilitation services in the community."
It is recognised that the situation with regard to accessing specialist neuro-rehabilitation services needs to be reviewed. Significant steps towards finding a resolution were taken with the publication in 2011 of the National Policy and Strategy for the Provision of Neuro-rehabilitation Services Ireland 2011-2015. The Rehabilitation Medicine Programme has also been developed within the Clinical Strategy and Programmes Directorate of the Health Service Executive.
A National Steering Group, chaired by the Head of the HSE’s Disability Reform Team, has completed an implementation framework in respect of the recommendations from the National Policy and Strategy. Membership of this Group includes representation from the HSE National Clinical Programmes for Rehabilitation Medicine and Neurology, HSE Primary Care, the Department of Health, Therapy Professions and the Neurological Alliance of Ireland. The Group is currently considering feedback on the framework, which was circulated to wider stakeholder interest groups. The HSE intends to finalise and progress implementation of the framework for the Neuro-rehabilitation Strategy in 2017.
In addition, capital funding is committed for the re-development of the National Rehabilitation Hospital in Dun Laoghaire. This funding will provide a new purpose-built 120 bed hospital with integrated therapy and support services on the Dun Laoghaire campus. It is expected that construction will commence in 2017.
56. Deputy Mick Barry asked the Minister for Health if his Department has studied the potential benefits to the public health care system that could arise if the demands of the Irish Nurses and Midwives Organisation, INMO, and the Irish Medical Organisation, IMO, for improvements in pay and working conditions were met from the point of view of retaining in the public health care system more of the doctors and nurses who are trained here; and if he will make a statement on the matter. [37994/16]
View answerThe Government and my Department recognise that difficulties recruiting and retaining doctors and nurses has the potential to impact negatively on patient care and service delivery. The Programme for a Partnership Government aims to recruit and retain talent within the public health service by implementing new procedures to ensure more efficient and timely recruitment of doctors and nurses. The Government has secured a total budget of €14.6 billion for the health service in 2017, the highest ever health budget. This funding will allow for the filling of a significant number of medical, nursing and other key service delivery posts.
A national integrated strategic framework for health workforce planning is being progressed by my Department. It is working with other Government Departments, the Health Service Executive and other agencies to implement an approach to workforce planning and development with the objectives of recruiting and retaining the right mix of staff. This National Integrated Strategic Framework for Health Workforce Planning is intended to reshape Ireland’s future health workforce planning to support and enable the productivity of the existing workforce and the recruitment and retention of a highly valued workforce. It will also encompass the expansion of the size, skills, competences and behaviours of the future workforce to meet current and emerging demands. It is expected that a report and a high level implementation plan will be submitted to the Minister in early 2017.
The MacCraith Group established in 2013 submitted three reports and made 25 recommendations aimed at improving the retention of medical graduates in the public health system and planning for future needs. My Department has established an Implementation Monitoring Group, comprising key stakeholders to support the implementation of the recommendations with each recommendation having an identified business owner. One of the Group's key recommendations led to improved new entrant pay scales for consultants implemented with effect from 1st September 2014.
There are many initiatives currently underway to improve nursing and midwifery staffing levels throughout the country. The HSE is focused on offering graduating nurses and midwives permanent posts and on replacing agency with permanent staff. A number of specific measures in relation to pay that will support the recruitment and retention have been taken including, the restoration of incremental credit for the 36 week undergraduate placement, higher rates of pay for the placement and additional pay for nurses taking on tasks previously undertaken by doctors.
My Department regularly engages with the Department of Public Expenditure and Reform on matters concerning pay and working conditions for medical and nursing personnel and methods to address recruitment and retention difficulties. Arrangements are in place to commence partial restoration of public service pay in 2017, reflecting the Government's recognition of the need to address pay and, at the same time, manage the public finances in a prudent manner. Further engagement with the staff side on pay and related matters is also in train as announced by my colleague the Minister for Public Expenditure and Reform on 29th November.
57. Deputy James Lawless asked the Minister for Health if his attention has been drawn to the fact that for eight years there was no consultant urologist at Temple Street Children's Hospital until the appointment of a consultant in summer 2016; if his attention has been further drawn to the fact that while this appointment is welcome there are a number of concerns (details supplied) raised by service users; and if he will make a statement on the matter. [37769/16]
View answerThe HSE has advised that there had been a vacancy for some time for a Consultant Paediatric Urologist at Temple Street Hospital as recruitment efforts for this very specific specialty post were not successful. However interim arrangements to provide specialist consultant input were put in place, including arrangements with a Consultant Paediatric Urologist in the NHS to visit Temple Street.
Since this Summer, a Consultant Urologist has been in post in Temple St Hospital. In addition, there are two Clinical Nurse Specialist assigned to the Spina Bifida service in Temple Street, with administrative support.
The challenge in accessing radiology services for urology is acknowledged as the radiological department in Temple Street provides services on an in-patient, out-patient and emergency basis and also provides a walk in service to GPs and a 24/7 MRI on-call service.
The challenge in accessing theatre for urology and other specialties is also acknowledged as the hospital has introduced rolling theatre closures due to nursing shortages. However the HSE has advised that the hospital is on a recruitment drive and was successful in recruiting six theatre nurses during 2016. There are plans to recruit a further five staff nurses in 2017 and the allocation of theatre sessions is robustly managed by the Theatre Manager to ensure that all available sessions are utilised to maximum capacity.
The HSE has also has advised that the Consultant Urologist is working closely with senior management at Temple Street Hospital to provide a service within the current resources, and that the hospital is very supportive of the Urologist in this regard.
58. Deputy Mick Wallace asked the Minister for Health the action he is taking to address the shortage of full-time residential care placements in County Wexford and the issues arising from respite care beds being occupied by service users whose needs would be better served in residential care units; the measures he is taking to provide additional respite care placements in County Wexford; if, further to Parliamentary Question No. 115 of 26 October 2016, he plans to allocate specific funding to open the Windrock respite facility in Murrintown, County Wexford; and if he will make a statement on the matter. [37773/16]
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.
The Programme for Partnership Government states that the Government wishes to provide more accessible respite care to facilitate full support for people with a disability.
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.
59. Deputy Lisa Chambers asked the Minister for Health the action he will take to address the fact that 854 persons were waiting over 18 months for an outpatient appointment at Mayo University Hospital in October 2016; and if he will make a statement on the matter. [38027/16]
View answerThis 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 be waiting less than 52 weeks for their first outpatient appointment. The latest NTPF Outpatient Waiting List figures indicate that 75% of people in Mayo University Hospital are waiting less than 52 weeks for their first outpatient appointment. 87% of people 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 day case 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, day case and also outpatient waiting times.
60. Deputy Clare Daly asked the Minister for Health if he has considered the findings of the surgical symphysiotomy ex gratia payment scheme report, with particular reference to the fact that the scheme refused to take survivor testimony as evidence; if he has made contact with a person (details supplied) or the survivor groups; and if he will make a statement on the matter. [37782/16]
View answerI met Judge Maureen Harding Clark on 19 October 2016 last when she submitted her report on the Surgical Symphysiotomy Payment Ex Gratia Scheme to me. I examined the report and submitted it to Government last week prior to its publication on my Department's website on 22 November last. I have not been in contact with the three survivor groups, as the work of the Scheme has now concluded.
The total cost of the Scheme was just under €34 million and payments of €50,000, €100,000 or €150,000 were made to 399 women, who met the criteria for an award. All of the women have received their respective payments totalling €29.85 million. The majority of claimants were over 75 years and payments were made to women between the ages of 51 and 96 years. 185 women who applied to the Scheme could not establish that they had a surgical symphysiotomy. Pubiotomy was frequently claimed but was established in only 1 case. Significant disability was established in this case.
As the Scheme was designed to be simple, straight forward and non-adversarial, the women were not expected to give oral testimonies as they might do in a court setting. In the interests of accountability, the Scheme required each applicant to prove that she had a surgical symphysiotomy or pubiotomy in order to be considered for the assessment of an award. The level of proof required was clearly set out in the terms of the Scheme. The Judge worked with each woman or her legal representative to locate medical records. The Judge met some women in different parts of the country where she considered this was necessary. Where claims could not be reconciled with established facts, women were examined by relevant medical experts.
Judge Clark encouraged women who believed they had a symphysiotomy to apply to the Scheme, advising them that they did not give up their right to pursue their case through the courts. It was only on accepting an award under the Scheme that a woman had to discontinue her legal proceedings. The vast majority of women opted to do so.
The brief given to Judge Clark in November 2014 was not an easy one. At that time the advice to the Department of Health was that many women would face an uphill struggle in proving their claims in the courts, with an uncertain outcome, as each case would be adjudicated on its merits. In her substantial Report Judge Clark has provided a comprehensive overview of the historical and medical context of symphysiotomy. Judge Clark had a unique opportunity to do this and her findings support the earlier findings of Prof Oonagh Walsh, whose report, commissioned by the Department of Health, was published in 2014.
Payments under the Scheme, together with the ongoing provision of medical services by the HSE, including medical cards, represent a comprehensive response to this issue by Government, which should help bring resolution to the women and their families.
62. Deputy Ruth Coppinger asked the Minister for Health the status of his discussions with the Irish Nurses and Midwives Organisation regarding pay restoration and recruitment and retention of nurses and midwives; and if he will make a statement on the matter. [37992/16]
View answerI met with a delegation from the INMO on 17 November to discuss a range of matters of concern to their membership including recruitment and retention difficulties. It was agreed at the meeting that the Department and the INMO would remain in contact over the coming weeks to progress a number of related matters raised at the meeting.
63. Deputy Ruth Coppinger asked the Minister for Health the steps he will take to end the high infant mortality rate among children in the Traveller community; and if he will make a statement on the matter. [33531/16]
View answerHealthy Ireland is our national framework for action to improve the health and well-being of the people of Ireland. Healthy Ireland takes a whole-of-Government and whole-of-society approach to improving health and well-being and the quality of people’s lives and provides an overarching approach to addressing health inequalities among Travellers.
The Government is committed to the implementation of Ireland’s first National Maternity Strategy - Creating a Better Future Together 2016 - 2026 which sets out the vision for the future of Ireland’s maternity services. The Strategy states that the National Women & Infants Health Programme will ensure that additional supports are provided to pregnant women from vulnerable, disadvantaged groups or ethnic minorities, and take account of the family's determinants of health.
In the context of these policy frameworks, the HSE addresses the health needs of Travellers by providing some traveller specific health services, largely in primary care, in order to link Travellers to mainstream services. To this end, the Traveller Primary Health Units (THUs) have been set up throughout the country to provide primary health care to Travellers in a culturally appropriate service model which comprises a partnership of health professionals - G.P.s, dedicated Nurse Specialists and Public Health Nurses - and traveller link workers.
The THUs teams have adopted a preventative/well-being model that promotes better health by linking infants and women to preventative public health and screening programmes. Improvements have been achieved in the rate of immunisation amongst traveller infants and increased presentation for developmental checks. Preventative programmes addressing cause specific issues for respiratory illness and other chronic conditions such as cardiovascular illness and Type 2 Diabetes are ongoing. As respiratory illness is the single most common presenting illness amongst Traveller infants, health promotion education and awareness programmes, through the THUs, play an important role in addressing the lifestyle factors such as smoking that contribute to infant mortality.
The THUs also provide advice on family planning and on pre and post natal care aimed at producing better health outcomes for mothers and infants. The All Ireland Traveller Health Study found that the interval between births to mothers in the Travelling Community to be much shorter than that within the general population. With the increase in contraceptive usage and breast feeding, which is being promoted by the THU's, the interval between births is expected to widen with the resultant beneficial impact on maternal health at birth and, consequently, on infant health and weight at birth.
Finally, the Department of Justice and Equality plays an important leadership role in developing a concerted response to Traveller needs, including health needs. That Department is leading on the development of a new National Traveller and Roma Inclusion Strategy. The Strategy aims to provide a set of specific actions that need to be taken to improve the situation for Traveller and Roma communities in Ireland. It is envisaged that the Strategy will include agreed actions in relation to improving the health of travellers.
64. Deputy Gino Kenny asked the Minister for Health the number and cost of assessments of needs under the Disability Act 2005 that were contracted out to therapists in private practice and or carried out by agency staff between 2011 and 2015; the reason HSE employed staff are not being used; and if he will make a statement on the matter. [37966/16]
View answerIn order to supplement the current service provided by the HSE and to reduce waiting times the HSE have contracted private therapists and agency staff to provide a service in identified areas. However, the information sought by the Deputy on the amount spent on commissioning therapists in private practice to undertake assessments under the assessment of need process is not routinely collated and aggregated into a statistical profile.
The HSE are currently reviewing costs for private therapy services expended via the nine CHO Areas and if the Deputy wishes to be advised of more up to date data in this area, we will endeavour to provide this detail at a later date. In the interim, a comprehensive data collection exercise was undertaken in 2013 to ascertain the number of private assessments (and associated costs) arranged during an 18 month period between 1 January 2012 and 30 June 2013. A total of 1,794 private assessments were commissioned at a total cost of €1,350,175.
The HSE endeavours to meet its legislative requirements for Assessment of Need reports and acknowledges the current challenges in achieving this. There were 3,318 Assessment of Need Reports completed in 2015. A total of 1,035 of these (31%) were completed within the timeframes set out in the Disability Act 2005. The length of time to complete the assessment of need will vary depending on the person’s complexity of need; however, the average duration of the assessment process per report completed in 2015 was 10.4 months.
The HSE continues to treat this issue as a priority and is putting in place a number of targeted initiatives in 2017 to improve the current timeframes. To this end, as part of its planning for 2017 there will be a number of specific actions including:
- prioritising assessments;
- holding additional clinics; and
- reconfiguring resources to target areas of greatest need.
Therapists in private practice have been contracted to conduct assessments, where appropriate. Guidance Notes have been issued to Assessment Officers for use when contracting private practitioners to undertake assessments under the Disability Act, to help ensure that children are being assessed in line with the provisions of the legislation and in line with the standards laid down by HIQA.
