Written Answers Nos 417-441
417. Deputy Dara Calleary asked the Minister for Health if further consideration has been given to making the life enhancing drug Nivolumab-Opdivo available to cancer patients; the discussions his Department has had with the HSE regarding the benefits of this new drug for cancer patients; and if he will make a statement on the matter. [8242/17]
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 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.
Under the HSE assessment process the National Centre for Pharmacoeconomics conducts health technology assessments of pharmaceutical products and can make recommendations on reimbursement to assist the HSE in its decision-making process.
Nivolumab is subject to separate health technology assessments for a number of different indications and as a combination therapy with Ipilimumab for cancer. The health technology assessments completed by the National Centre for Pharmacoeconomics to date have not recommended reimbursement; evaluations for the other indications are still ongoing.
The statutory assessment process is ongoing.
418. Deputy Dara Calleary asked the Minister for Health if he will sanction financial support for cancer patients undergoing life saving treatment (details supplied) in private hospitals, which is currently not available through the HSE; if his attention has been drawn to the fact that these treatments are costing patients up to €3,300 a time; if he will consider making allowances for medical card holders with limited means who find themselves in such situations; and if he will make a statement on the matter. [8243/17]
View answerIt is assumed that the Deputy is referring to reimbursement of the medicine prior to such a decision being taken by the HSE.
The Health (Pricing and Supply of Medical Goods) Act 2013 established a list of drugs which may be supplied to eligible persons, under Section 59 of the Health Act 1970. The Health (Pricing and Supply of Medical Goods) Act 2013 gives full statutory authority to the HSE to add new drugs to the list. The Act sets out the specific criteria that the HSE must make such a decision in accordance with.
There is no provision in the Act to provide financial support to medical card patients in the circumstances outlined by the Deputy.
419. Deputy Fergus O'Dowd asked the Minister for Health how many of the nine speech and language therapists allocated to the Louth and Meath services in 2016 that have started in their roles; if any other staff allocations have been made in this section to date in 2017; and if there are plans to allocate any further resources to the area in 2017 for the Louth and Meath area [8258/17]
View answerAs this question relates to service matters, I have arranged for the question to be referred to the Health Service Executive (HSE) for direct reply.
420. Deputy Fergus O'Dowd asked the Minister for Health the position regarding the waiting list for counties Louth and Meath for speech and language therapy assessment and intervention for each of the years 2015 and 2016 and to date in 2017, in tabular form; and if he will make a statement on the matter. [8259/17]
View answerAs this question relates to service matters, I have arranged for the question to be referred to the Health Service Executive (HSE) for direct reply.
421. Deputy Louise O'Reilly asked the Minister for Health the age profile of public health nurses by age decile; the numbers per head of population; the geographic area covered by public health nurses, by county; and if he will make a statement on the matter. [8262/17]
View answerI have asked the HSE to respond to the Deputy directly on this matter.
422. Deputy Louise O'Reilly asked the Minister for Health the number of community paramedics employed by the HSE, by county; and if he will make a statement on the matter. [8263/17]
View answerI have asked the HSE to respond to the Deputy directly on this matter.
423. Deputy Louise O'Reilly asked the Minister for Health the number of persons employed in speech and language services at different grades, by county; and if he will make a statement on the matter. [8264/17]
View answerI have asked the HSE to respond to the Deputy directly on this matter.
424. Deputy Louise O'Reilly asked the Minister for Health the number of persons employed in the mental health services at different grades, by county; and if he will make a statement on the matter. [8265/17]
View answerI have asked the HSE to respond to the Deputy directly on this matter.
425. Deputy Louise O'Reilly asked the Minister for Health the number of persons employed to provide disability services in HSE services and in services provided for the HSE and by a third party, by grade and by county; and if he will make a statement on the matter. [8266/17]
View answerI have asked the HSE to respond to the Deputy directly on this matter.
426. Deputy Louise O'Reilly asked the Minister for Health the number of persons employed by the HSE in social inclusion services and their grades, by county; and if he will make a statement on the matter. [8267/17]
View answerI have asked the HSE to respond to the Deputy directly on this matter.
427. Deputy Louise O'Reilly asked the Minister for Health the numbers of persons in nursing homes run by the HSE, by county; number of persons accommodated in private nursing homes as a result of financial supports from the HSE, with a breakdown by scheme, such as fair deal and so on; and if he will make a statement on the matter. [8268/17]
View answerAs this is a service matter it has been referred to the Health Service Executive for direct reply.
428. Deputy Louise O'Reilly asked the Minister for Health the number of staff employed directly by the HSE to provide community dental services, by grade and by county; the number of persons receiving treatment paid for by the HSE in private services in 2016; the overall amount paid by the HSE for those services; and if he will make a statement on the matter. [8269/17]
View answerAs this is a service matter it has been referred to the HSE for reply to the Deputy.
429. Deputy Fiona O'Loughlin asked the Minister for Health if he will review the case of a person (details supplied); and if he will make a statement on the matter. [8273/17]
View answerUnder the Health Act 2004, the Health Service Executive (HSE) is required to manage and deliver, or arrange to be delivered on its behalf, health and personal social services. Section 6 of the HSE Governance Act 2013 bars the Minister for Health from directing the HSE to provide a treatment or a personal service to any individual or to confer eligibility on any individual.
The Health Service Executive has been asked to examine this matter and to reply to the Deputy as soon as possible.The Health Service Executive operates the General Medical Services scheme, which includes medical cards and GP visit cards, under the Health Act 1970, as amended. It has established a dedicated contact service for members of the Oireachtas specifically for queries relating to medical cards and GP visit cards, which the Deputy may wish to use for an earlier response. Contact information was issued to Oireachtas members.
430. Deputy Niamh Smyth asked the Minister for Health the reason a person (details supplied) has no language or speech therapist. [8275/17]
View answerThe Government is committed to providing services and supports for people with disabilities which will empower them to live independent lives, provide greater independence in accessing the services they choose, and enhance their ability to tailor the supports required to meet their needs and plan their lives. This commitment is outlined in the Programme for Partnership Government, which is guided by two principles: equality of opportunity and improving the quality of life for people with disabilities.
As the Deputy's question relates to an individual case, I have arranged for the question to be referred to the Health Service Executive (HSE) for direct reply to the Deputy.
431. Deputy Timmy Dooley asked the Minister for Health when a person (details supplied) in County Clare will receive an appointment for the primary medical certificate; and if he will make a statement on the matter. [8276/17]
View answerAs 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.
432. Deputy Fergus O'Dowd asked the Minister for Health if under existing legislation products containing CBD oil could be provided to patients here without breaking the law under the misuse of drugs legislation. [8277/17]
View answerTHC and CBD are both derived from cannabis. THC is a psychoactive substance and as such is strictly controlled under the Misuse of Drugs Act 1977, as amended, and Ministerial regulations made thereunder along with the cannabis plant.
However, since CBD does not have psychoactive properties it is not controlled under the Misuse of Drugs Acts. There is no prohibition on an Irish registered doctor recommending CBD for a patient under his/her care if they deem that treatment option to be clinically appropriate for their patient.
I am aware that CBD oil is sometimes marketed as a nutritional or dietary supplement, and it is reported that a number of Irish patients are accessing CBD Oil from shops or online and using it to self-medicate for a variety of medical conditions. However, it should be noted that it is not authorised as a medicinal product in Ireland.
Under European and Irish legislation, before a medicine can be placed on the Irish market, the manufacturer must seek an authorisation from the Health Products Regulatory Authority (HPRA) or, in the case of certain medicinal products, the European Medicines Agency. A determination on an application for authorisation of a medicinal product is based on a rigorous scientific assessment of the application against the criteria of safety, quality, efficacy, legal and regulatory requirements. I have no role in the process of medicinal product authorisation.
433. Deputy Michael Healy-Rae asked the Minister for Health if he will address an issue regarding the HSE not providing payslips to employees (details supplied); and if he will make a statement on the matter. [8279/17]
View answerI have asked the HSE to respond to the Deputy directly on this matter.
434. Deputy Barry Cowen asked the Minister for Health when a person (details supplied) can expect an appointment at St. James's Hospital, Dublin. [8281/17]
View answerUnder the Health Act 2004, the Health Service Executive (HSE) is required to manage and deliver, or arrange to be delivered on its behalf, health and personal social services. Section 6 of the HSE Governance Act 2013 bars the Minister for Health from directing the HSE to provide a treatment or a personal service to any individual or to confer eligibility on any individual.
The scheduling of appointments for patients is a matter for the hospital to which the patient has been referred. Should a patient's general practitioner consider that the patient's condition warrants an earlier appointment, he or she should take the matter up with the consultant and the hospital involved. In relation to the specific case raised, I have asked the HSE to respond to you directly.
435. Deputy Éamon Ó Cuív asked the Minister for Health the reason the HSE cancelled a medical card application, as happened in a case (detailed supplied); his plans to open the application taking into the consideration the exceptional circumstances that have arisen in this case; and if he will make a statement on the matter. [8283/17]
View answerUnder the Health Act 2004, the Health Service Executive (HSE) is required to manage and deliver, or arrange to be delivered on its behalf, health and personal social services. Section 6 of the HSE Governance Act 2013 bars the Minister for Health from directing the HSE to provide a treatment or a personal service to any individual or to confer eligibility on any individual. The Health Service Executive has been asked to examine this matter and to reply to the Deputy as soon as possible.
The Health Service Executive operates the General Medical Services scheme, which includes medical cards and GP visit cards, under the Health Act 1970, as amended. It has established a dedicated contact service for members of the Oireachtas specifically for queries relating to medical cards and GP visit cards, which the Deputy may wish to use for an earlier response. Contact information was issued to Oireachtas members.
436. Deputy Fiona O'Loughlin asked the Minister for Health the procedure that persons must follow to secure funding for lifesaving treatment which is not available here; and if he will make a statement on the matter. [8289/17]
View answerThe HSE operates the Treatment Abroad Scheme (TAS) for persons entitled to treatment in another EU/EEA Member State or Switzerland under EU Regulation (EC) No. 883/2004, as per the procedures set out in EU Regulations (EC) No. 987/2009, and in accordance with Department of Health Guidelines. Patients apply to the HSE TAS seeking access to public healthcare outside the State through model form E112. Subject to the EU Regulations and Guidelines, the TAS provides for the cost of approved treatments in another EU/EEA member state or Switzerland through the issue of form E112 (IE) where the treatment is:
- Among the benefits provided for by Irish legislation,
- Not available in Ireland,
- Not available within the time normally necessary for obtaining it in Ireland, taking account of the patient's current state of health and the probable course of the disease.
Applications to TAS are processed and a determination given in accordance with the statutory framework prior to a patient travelling to avail of treatment. The statutory framework stipulates the patient must be a public patient and is required to have followed public patient pathways. GPs refer patients to consultants for acute care and it is the treating consultant who, having exhausted all treatment options including tertiary care within the country, refers the patient abroad under the terms of the TAS. The consultant must specify the specific treatment and in making the referral accepts clinical responsibility in relation to the physician and facility abroad where the patient will attend.
Each application is reviewed individually and a decision is made in accordance with the legislation and guidelines and on the basis of a review by clinical experts. Each application is given a formal written decision and where a decision is one of decline, the reason for that decision is clearly outlined and the option of an appeal is afforded. Previous approvals or declines are not used as an influencing factor on subsequent applications. The appeals process is outlined in each decline letter without exception. Where on appeal a decline decision is upheld, the appeal decision letter advises that the applicant can make a further appeal to the Office of the Ombudsman.
437. Deputy Joan Collins asked the Minister for Health the total number of contracted service providers from the NGO, charity, religious bodies and voluntary sectors to the HSE; and the total sum provided for that service provision in 2016. [8294/17]
View answerI have referred the query to the HSE for direct response to the Deputy.
438. Deputy Mattie McGrath asked the Minister for Health the detail of all funding provided for the construction of a national paediatric hospital since 2006, including the proposed Mater Hospital site; and if he will make a statement on the matter. [8303/17]
View answerThe new children's hospital project is included in the HSE Capital Plan. Funding for the project is provided to the National Paediatric Hospital Development Board by the HSE.
I have asked the HSE to provide the Deputy with details of the capital funding allocated to this project since 2006.
439. Deputy Pearse Doherty asked the Minister for Health when a decision will be made in respect of a medical card application for a person (details supplied) in County Donegal; and if he will make a statement on the matter. [8313/17]
View answerUnder the Health Act 2004, the Health Service Executive (HSE) is required to manage and deliver, or arrange to be delivered on its behalf, health and personal social services. Section 6 of the HSE Governance Act 2013 bars the Minister for Health from directing the HSE to provide a treatment or a personal service to any individual or to confer eligibility on any individual. The Health Service Executive has been asked to examine this matter and to reply to the Deputy as soon as possible.
The Health Service Executive operates the General Medical Services scheme, which includes medical cards and GP visit cards, under the Health Act 1970, as amended. It has established a dedicated contact service for members of the Oireachtas specifically for queries relating to medical cards and GP visit cards, which the Deputy may wish to use for an earlier response. Contact information was issued to Oireachtas members.
440. Deputy Peter Burke asked the Minister for Health if certain expenses such as travel costs and medical staff care expenses can be given to medical card holders that are resident in nursing homes, in situations in which persons must attend doctor's appointments and require HSE staff to accompany them in a taxi; and if he will make a statement on the matter. [8319/17]
View answerThe Nursing Homes Support Scheme (NHSS), commonly referred to as A Fair Deal, is a system of financial support for people who require long-term residential care. Participants contribute to the cost of their care according to their means while the State pays the balance of the cost.
The NHSS covers the cost of the standard components of long-term residential care which are:
- Nursing and personal care appropriate to the level of care needs of the person;
- Bed and board;
- Basic aids and appliances necessary to assist a person with the activities of daily living; and
- Laundry service.
A person's eligibility for other schemes, such as the medical card scheme or the drugs payment scheme, is unaffected by participation in the NHSS or residence in a nursing home. In determining the services covered by the NHSS it was considered very important that the care recipient and the taxpayer would be protected and would not end up paying for the same services twice. For this reason, medications and aids that are already prescribed for individuals under an existing scheme are not included in the services covered by the NHSS, as this would involve effectively paying twice for the same service.
As transport is not a core health service it is not covered by the medical card.
Although the NHSS covers core living expenses, residents can still incur some costs in a nursing home. In recognition of this, anyone in receipt of financial support under the NHSS retains at least 20% of their income. The minimum amount that is retained is the equivalent of 20% of the State Pension (Non-Contributory). An operator should not seek payment from residents for items which are covered by the NHSS, the medical card or any other existing scheme.
441. Deputy Peter Burke asked the Minister for Health if certain issues (details supplied) are being considered in the fair deal scheme review; and if he will make a statement on the matter. [8320/17]
View answerThe Nursing Homes Support Scheme (NHSS) is a system of financial support for those in need of long-term nursing home care. Participants contribute to the cost of their care according to their income and assets while the State pays the balance of the cost. The Scheme aims to ensure that long-term nursing home care is accessible and affordable for everyone and that people are cared for in the most appropriate settings.
A financial assessment is carried out by the HSE to determine how much a participant in the Scheme will contribute to the cost of their care. Participants in the Scheme contribute up to 80% of their assessable income and a maximum of 7.5% per annum of the value of assets held. In the case of a couple, the applicant’s means are assessed as 50% of the couple’s combined income and assets. The first €36,000 of an individual’s assets, or €72,000 in the case of a couple, is not counted at all in the financial assessment. The capital value of an individual’s principal private residence is only included in the financial assessment for the first three years of their time in care. This is known as the three year cap.
Importantly, a farm (or relevant business) can also qualify for this three year cap where unexpected health events prevent early succession arrangements. This applies where:
a) The applicant has suffered a sudden illness or disability which caused them to require care services and
b) A substantial part of the working day of the applicant or their partner was regularly and consistently applied to the farming of the farm or carrying on of the relevant business until the onset of the sudden illness or disability, and
c) A family successor certifies in writing that he or she will on a consistent and regular basis apply a substantial part of his or her working day to the farming of the farm or the carrying on of the relevant business.
When the NHSS commenced in 2009, a commitment was made that it would be reviewed after three years. The Review was published in July 2015. A number of key issues have been identified for more detailed consideration across Departments and Agencies, including the treatment of business and farm assets for the purposes of the financial assessment element of the Scheme.
An Interdepartmental/Agency Working Group has been established to progress certain recommendations contained in the Review. This Group is chaired by the Department of Health and includes representatives from the Department of the Taoiseach, the Department of Public Expenditure and Reform, the HSE, the Revenue Commissioners and, when required, the National Treatment Purchase Fund. The IFA made a submission to the Working Group on the treatment of farms for the purposes of the Scheme. These proposals are currently being considered. An initial report on progress was submitted to the Cabinet Committee on Health in September 2016. The Programme for a Partnership Government has also committed to reviewing the NHSS to remove any discrimination against small business and family farms.
The Fair Deal Scheme operates under the Nursing Homes Support Scheme Act, 2009. There are no provisions in the Act to reimburse family members for out of pocket expenses for visiting relations in nursing homes. Under the Scheme, the choice of nursing home lies with the applicant, who can choose any public, voluntary or approved private nursing home. The home must have availability and be able to cater for the applicant's particular needs.
