Tuesday, 13 Dec 2016

Written Answers Nos. 511-34

Emergency Departments

Questions (511, 512)

Brian Stanley

Question:

511. Deputy Brian Stanley asked the Minister for Health the timeframe for his Department to complete its consideration of the plan it has received again on the future of services at Portlaoise hospital. [40024/16]

Brian Stanley

Question:

512. Deputy Brian Stanley asked the Minister for Health the details of the Government policy regarding the continuation of emergency department services at Portlaoise hospital; his views on the matter in the context of under-capacity in the system across the State; and if he will make a statement on the matter. [40025/16]

Written answers

Minister for Health

I propose to take Questions Nos. 511 and 512 together.

My Department and the HSE are committed to securing and developing the role of Portlaoise Hospital within the Dublin Midlands Hospital Group.

The most important issue in relation to any changes at Portlaoise Hospital is that patient safety and good quality outcomes must come first. Reports on Portlaoise Hospital in recent years point to the need for reconfiguration of some services to ensure that patients are treated in the most appropriate setting by specialist staff that can safely meet their needs.

The Group has been working for some time on a draft plan for a new model of clinical service delivery at Portlaoise Hospital which takes account of the need to develop services at Portlaoise in the context of developing the model of service provision for the entire Hospital Group.

The HSE has now submitted the draft plan to my Department and it will now be reviewed in detail by the Department. Any changes to services at Portlaoise, once approved, will be undertaken in a planned and orderly manner and will take account of existing patient flows and demands in other hospitals and the need to develop particular services at Portlaoise in the context of overall service configuration in the Dublin Midlands Group.

Orthodontic Services Waiting Lists

Questions (513)

Ruth Coppinger

Question:

513. Deputy Ruth Coppinger asked the Minister for Health the measures he is taking to reduce the waiting time for specialist orthodontists which is currently over four years (details supplied); and if he will make a statement on the matter. [40031/16]

Written answers

Minister for Health

As this is a service matter it has been referred to the HSE for reply to the Deputy.

Hospital Beds Data

Questions (514)

Sean Fleming

Question:

514. Deputy Sean Fleming asked the Minister for Health if his Department told the Committee on the Future of Healthcare that based on current tender returns and space standards, the construction costs of a replacement hospital bed is in the region of €325,000 not including equipping costs, and that annual ongoing revenue costs of operating an additional hospital bed run to €78,000 per year; and if so, if the information provided by the HSE in response to Parliamentary Question No. 425 of 17 December 2015 is accurate in view of his Department's submission. [40033/16]

Written answers

Minister for Health

The submission to the Dáil Committee for the Future of Healthcare quoted €325,000 for the capital cost of a bed, and €78,000 for running costs. The figure of €325,000 is based on the capital costs of building new ward space to accommodate an additional bed, and does not include additional equipping costs, or the costs of providing the necessary associated hospital infrastructure (theatres, laboratories etc.) that would be required to service large expansions in bed capacity.

In the context of a larger expansion of hospital bed capacity, the HSE estimate that the total costs of the development of a bed could be around €1 million per bed.

Similarly, the figure of €78,000 annual running costs (€500 per week) provided to the Dáil Committee for the Future of Healthcare is derived from estimates for the provision of additional beds within existing infrastructure, and not those associated with any substantial expansion of facilities and staffing. In the context of a major expansion of bed capacity, the HSE estimate that the running cost of a bed would be in the region of €839 per day, giving a total annual cost per bed of €306,000.

The figures quoted in the submission to the Committee for the Future of Healthcare, and the information provided by the HSE in response to Parliamentary Question No. 425 of 17 December 2015, apply in different circumstances.

All costings above are subject to very significant caveats, as considerations such as the bed type (e.g. intensive care, coronary care, high dependency, and general ward), specialty usage (e.g. orthopaedics, neurosurgery, general medicine) and current location, infrastructure and layout of individual hospital sites, all of which impact on the prospective costs of bed capacity provision.

Drugs Payment Scheme Coverage

Questions (515)

Jan O'Sullivan

Question:

515. Deputy Jan O'Sullivan asked the Minister for Health if negotiations are to commence between a company (details supplied) and the HSE on 15 December 2016; and if he will make a statement on the matter. [40040/16]

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 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 and weighing less than 25 kg. 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 who may be 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 negotiations with manufacturers, I have asked it 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 statutory process, as set out in the 2013 Act.

Question No. 516 answered with Question No. 469.

Hospital Consultant Recruitment

Questions (517)

Paul Murphy

Question:

517. Deputy Paul Murphy asked the Minister for Health the plans in place to provide a consultant to deal with chronic fatigue syndrome; if plans are in place to open a HSE clinic or unit specialising in the illness; and if he will make a statement on the matter. [40044/16]

Written answers

Minister of State at the Department of 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 to the Deputy.

Medicinal Products Licensing

Questions (518)

Peter Burke

Question:

518. Deputy Peter Burke asked the Minister for Health if he will address a matter (details supplied) regarding a drug that treats ME; and if he will make a statement on the matter. [40050/16]

Written answers

Minister for Health

Rintatolimod (brand name Ampligen) is an experimental drug in development for the treatment of a variety of chronic diseases and viral disorders, including Chronic Fatigue Syndrome or Myalgic Encephalomyelitis (ME).

The drug has not been authorised by the European Medicines Agency for the treatment of ME in the European Union. If the drug should receive marketing authorisation in Ireland, it would then be open to the marketing authorisation holder to make the drug available for prescribing, and to apply to the HSE to have the product reimbursed under the State drugs schemes.

I understand that the U.S. Food and Drug Administration (FDA) has declined to approve rintatolimod for use in the U.S., despite conducting several reviews of the drug over the last decade.

Question No. 519 answered with Question No. 420.

Primary Care Centres Provision

Questions (520)

Éamon Ó Cuív

Question:

520. Deputy Éamon Ó Cuív asked the Minister for Health the proposals in place to replace the substandard health centre on Inishbofin Island with a suitable purpose-built building; the reason for the inordinate delay with this project; and if he will make a statement on the matter. [40079/16]

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.

Health Services Staff Training

Questions (521)

Éamon Ó Cuív

Question:

521. Deputy Éamon Ó Cuív asked the Minister for Health the details of his discussions with the Minister for Education and Skills to ensure that the shortage of persons with Quality and Qualifications Ireland, QQI, level 5 qualifications in health care support is overcome in view of the shortage of care assistants available to public and private home care and other health care providers; the results of such discussion; and if he will make a statement on the matter. [40080/16]

Written answers

Minister for Health

In November 2016, a working group, with an independent chair, was established by the HSE to conduct a comprehensive review of the role and function of the Health Care Assistant in the health service. It is expected that the work of the group will include a consideration of the educational qualification requirements for the role. The group will engage, as appropriate, with relevant bodies during the course of its work.

Protected Disclosures

Questions (522, 523, 524, 525, 526, 527, 528, 529)

Donnchadh Ó Laoghaire

Question:

522. Deputy Donnchadh Ó Laoghaire asked the Minister for Health his views on reports of significant risks being caused by failure of infection controls at University Hospital Limerick; and if he will make a statement on the matter. [40086/16]

Donnchadh Ó Laoghaire

Question:

523. Deputy Donnchadh Ó Laoghaire asked the Minister for Health if he has received a protected disclosure regarding risks of infection controls at University Hospital Limerick; and the action he has taken in this regard. [40087/16]

Donnchadh Ó Laoghaire

Question:

524. Deputy Donnchadh Ó Laoghaire asked the Minister for Health if the person who has made the protected disclosure to him regarding University Hospital Limerick has returned to work at the hospital. [40088/16]

Donnchadh Ó Laoghaire

Question:

525. Deputy Donnchadh Ó Laoghaire asked the Minister for Health if he will consider a full inquiry if it is established that the failure of infection controls at University Hospital Limerick led to avoidable deaths. [40089/16]

Donnchadh Ó Laoghaire

Question:

526. Deputy Donnchadh Ó Laoghaire asked the Minister for Health the action taken by his Department following the concerns expressed by HIQA regarding infection controls at University Hospital Limerick; and if any actions remain outstanding. [40090/16]

Donnchadh Ó Laoghaire

Question:

527. Deputy Donnchadh Ó Laoghaire asked the Minister for Health if the Health Protection Surveillance Centre, HPSC, made a report into infection control at University Hospital Limerick and if he received it; if it was published; the action taken by his Department following receipt of this report; and his views on the detail stated in this report. [40091/16]

Donnchadh Ó Laoghaire

Question:

528. Deputy Donnchadh Ó Laoghaire asked the Minister for Health if there have been more deaths due to infection at University Hospital Limerick than the average at major hospitals. [40092/16]

Donnchadh Ó Laoghaire

Question:

529. Deputy Donnchadh Ó Laoghaire asked the Minister for Health if his attention has been drawn to the fact that there has been a significant turnover of staff in infection control at University Hospital Limerick in the past two years; if it is of the order of 50%; and his views on staff leaving positions in infection control. [40093/16]

Written answers

Minister for Health

I propose to take Questions Nos. 522 to 529, inclusive, together.

Multidrug-resistant infections and resistance to antibiotics are an ongoing and evolving international risk for all healthcare providers. I can assure the Deputy that the prevention and control of healthcare associated infections and antimicrobial resistance is a significant patient safety and public health priority for the Government.

I am advised that Irish hospitals, like other hospitals internationally, are taking steps to reduce healthcare associated infections and antimicrobial resistance including the prudent use of antibiotics. I am aware of the challenges in relation to tackling multidrug-resistant superbug infection rates in all hospitals including at University Hospital Limerick (UHL). UHL has confirmed that a focused Quality Improvement Plan is in place to tackle the issues of control of healthcare associated infections and antimicrobial resistance, commonly known as HCAIs and AMR. This is in line with the recommendations of the HIQA unannounced inspection reports at the Hospital on 28 November 2014 and 13 January 2015.

This includes:

- An intensive screening programme for the detection of Carbapenem Resistant Enterobacteriaceae, CRE among high risk patients;

- An isolation ward for the mitigation of any risk of cross-transmission of newly detected or known positive patients;

- Adoption of strict contact precautions, dedicated equipment and a highly intensive cleaning regimen;

- Speedy laboratory procedures to ensure results regarding infections available within 24 hours;

- Good communication amongst microbiologists and with all relevant parties on detection of a new case.

- Good communication with patients and GPs and other health care worker contacts to inform GPs of their patients’ status.

A wide range of initiatives has been put in place in the Irish health system over several years to tackle healthcare associated infections and antimicrobial resistance, covering improved surveillance of infections and prescribing and infection prevention and control processes.

It also includes antimicrobial stewardship initiatives, public and professional awareness-raising with a significant emphasis on the education and training of healthcare professionals.

Ireland is also developing a National Action Plan on Antimicrobial Resistance in line with the World Health Organisation's 2015 Global Action Plan on AMR and the European Council’s 2016 Conclusions: 'The next steps under a 'One Health' approach to combat antimicrobial resistance'.

The National Action Plan is being developed with the oversight and guidance of the Interdepartmental AMR Consultative Committee. The Committee was established in 2014 by my Department’s Chief Medical Officer and the Chief Veterinary Officer of the Department of Agriculture, Food and the Marine in recognition of the need for a ‘whole of Government’ approach to tackling the issue of AMR. This inter-sectoral approach crosses the health, veterinary and environmental spheres to encompass all stakeholders’ efforts to address what is a world-wide concern. It is intended that the National Action Plan will be published in 2017.

The Health Protection Surveillance Centre (HPSC) is Ireland's specialist agency for the surveillance of communicable diseases and is part of the Health Service Executive. HPSC works in partnership with health service providers and sister organisations in Ireland and around the world and collates, interprets and disseminates data and information on communicable diseases.

Tackling AMR will require the whole system to prioritise key initiatives, working with our international colleagues. Ireland is fully committed to and engaged in addressing resolution of the problem of AMR and will continue to collaborate at international, EU and national levels to this end.

Nationally, I expect that the HSE will place particular emphasis on prevention and management of healthcare associated infections and antimicrobial resistance in its service planning for 2017.

Protected disclosures received by the Minister for Health are managed in accordance with the requirements under the Protected Disclosures Act 2014. It would not be appropriate for me to comment on such matters.

The Deputy’s detailed queries in relation to the publication of an HPSC report into infection control at UHL, deaths due to infection at the hospital relative to deaths at other major hospitals, and regarding staff turnover are operational issues and have, therefore, been referred to the HSE for direct reply.

Question No. 530 answered with Question No. 469.

Drugs Payment Scheme Coverage

Questions (531)

Michael McGrath

Question:

531. Deputy Michael McGrath asked the Minister for Health his plans to make a certain device (details supplied) available under the general medical card scheme; if so, when he expects this to happen; and if he will make a statement on the matter. [40100/16]

Written answers

Minister for Health

The HSE has statutory responsibility for decisions on pricing and reimbursement of medicinal devices under the community drug schemes 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.

Legislative Programme

Questions (532)

Michael Moynihan

Question:

532. Deputy Michael Moynihan asked the Minister for Health the name and number of Bills in preparation in his Department and published by his Department since May 2016; the stage each Bill is at in the Houses of the Oireachtas; the number of Bills from his Department signed into law; and if he will make a statement on the matter. [40137/16]

Written answers

Minister for Health

The information requested by the Deputy is shown in the following tables:

May 2016 to date - Bills published, current stage and Bills enacted
Bill	Enacted/current stage
Health (Amendment) Bill 2016	Enacted
Misuse of Drugs (Amendment) Bill 2016	Enacted
The Health Insurance (Amendment) Bill 2016	Passed by Dáil Eireann and scheduled for Committee and Report Stages in Seanad Eireann week beginning 12 December 2016

	Bills in preparation
1.	Health (Amendment) (No. 2) Bill
2.	Misuse of Drugs (Supervised Injecting Facilities) Bill (formerly Misuse of Drugs (Amendment) (No. 2) Bill)
3.	Health Information and Patient Safety Bill
4.	Health (Transport Support) Bill
5.	Health (Miscellaneous Provisions) (No. 2) Bill
6.	Assisted Human Reproduction Bill
7.	Health & Well-being (Calorie Posting and Workplace Well-being) Bill
8.	Health Act 2007 (Amendment) Bill
9.	Human Tissue Bill
10.	New Children's Hospital Establishment Bill
11.	Patient Safety (Licensing of Healthcare Facilities) Bill
12	Public Health (Sale of Tobacco Products & Non-Medical Nicotine Delivery Systems) Bill
13.	Provisions to support open disclosure of patient safety incidents to patients, for inclusion in the Department of Justice and Equality's Civil Liability (Amendment) Bill

Question No. 533 answered with Question No. 469.

GLAS Payments

Questions (534)

Michael Healy-Rae

Question:

534. Deputy Michael Healy-Rae asked the Minister for Agriculture, Food and the Marine the status of a 2016 GLAS payment in respect of a person (details supplied); and if he will make a statement on the matter. [39382/16]

Written answers

Minister for Agriculture, Food and the Marine

The person named was approved for Tranche 1 of GLAS (GLAS 1) with effect from 1 October 2015 and all payments due have issued in respect of the 2015 scheme year.

Applications are currently being processed in respect of the 2016 scheme year with a view to issuing the first instalment on applications that successfully complete the necessary prepayment checks shortly.