Written Answers Nos. 159-169
159. Deputy Peadar Tóibín asked the Minister for Arts, Heritage, Regional, Rural and Gaeltacht Affairs if progress has been made in the provision and planning for the 383,000 young persons served by the non-formal or youth work sector to access the arts (details supplied); the stakeholders her Department is in dialogue with in this regard; and if she will make a statement on the matter. [21300/17]
View answer160. Deputy Peadar Tóibín asked the Minister for Arts, Heritage, Regional, Rural and Gaeltacht Affairs the implications of her plan to fast-track the implementation of the Arts in Education Charter; if this will impact on provision for 383,000 young persons, many of whom are young persons with fewer opportunities involved in the non-formal and youth work sector; and if she will make a statement on the matter. [21301/17]
View answerI propose to take Questions Nos. 159 and 160 together.
The Creative Ireland Programme, which the Taoiseach and I launched in December, places a special focus on “Enabling the Creative Potential of Every Child”. Building on the Arts in Education Charter this will involve the development of an integrated plan – Creative Children - to enable every child in Ireland to access tuition in music, drama, art and coding by 2022. My Department officials continue to work with relevant Departments and other stakeholders to develop this plan with a launch timeframe of early Autumn 2017.
The Creative Childen plan will build on work to date in implementing the Arts in Education Charter where my Department continues to work closely with the Department of Education and Skills, the Department of Youth and Children Affairs and the Arts Council to deliver the key objectives of the Charter within the wider context now of the Creative Ireland Programme to include non-mainstream education.
The objectives of the Charter have been achieved largely through existing structures such as education centres. Good progress has been made to date in terms of launching Ireland’s first Arts in Education Portal, holding National Arts and Education Days and developing Teacher Artist Partnerships through the Education and Training Centres. Indeed, I look forward to attending the next National Arts Day, this Saturday 6 May, in St Patrick's College DCU, Drumcondra.
Arising from the significant increase of support of €5m which I secured for the Arts Council as part of Budget 2017, I am pleased that the Arts Council decided to increase funding in this area for 2017 from €3.1m in 2016 to €3.7m this year.
These initiatives demonstrate the overall commitment of Government to deliver for children as we work in finalising the Creative Children plan.
161. Deputy Kathleen Funchion asked the Minister for Health the hourly cost for ten HSE therapists employed as part of level 6 of the access and inclusion model, AIM, for children with additional needs taking part in the free preschool year. [21163/17]
View answer162. Deputy Kathleen Funchion asked the Minister for Health the duties of a HSE therapist working as part of level 6 in AIM; the number of hours a therapist spends with a child per day; and the number of days a week. [21164/17]
View answer163. Deputy Kathleen Funchion asked the Minister for Health if a HSE therapist working with a child as part of AIM works consistently with the same child over a period of time or if the therapist changes every visit. [21165/17]
View answerI propose to take Questions Nos. 161 to 163, inclusive, together.
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.
164. Deputy Brian Stanley asked the Minister for Health when approval will be given for the recruitment of dental surgeons for the Laois catchment area. [21140/17]
View answerI have asked the HSE to respond to the Deputy directly on this matter.
165. Deputy Brendan Ryan asked the Minister for Health his plans to include the provision of homecare in the fair deal scheme; and if he will make a statement on the matter. [21144/17]
View answerThe Nursing Homes Support Scheme is a scheme of financial support towards the cost of long term residential care. Residents make a contribution towards the cost of their care based on their means and the State pays the balance. In order to avail of support under the scheme a person must be assessed as needing long term residential care. However, Government policy is to support older people to remain in their own homes for as long as possible.
Government considers that a standalone funding scheme, designed for home care and recognising its particular characteristics, together with regulation of these services is needed. However a significant amount of detailed preparation needs to be done before final decisions are taken on the form of a home care scheme and the regulation of these services. This is required if reforms are to be successful, affordable and sustainable.
In this regard, the Department of Health is currently engaged in a detailed process to determine what type of home care scheme is best for Ireland. As an initial step in this process, the Department commissioned the Health Research Board to undertake an evidence review of the home care systems that are in place in four other European countries. This review was published on 11 April. The Review will help us to learn from the experiences of other jurisdictions and will inform the debate and future consideration of approaches to formal home care financing and regulation here in Ireland.
Another important step in this process is a public consultation process which I will be launching at the end of May. The purpose of this consultation is to allow all those who have views on this topic to have their say, including older people themselves, their families, and healthcare workers.
166. Deputy Robert Troy asked the Minister for Health if he will include drugs to treat anxiety disorder in the list of long term illness drugs in view of the fact they are not covered by the drug refund scheme or a medical card. [21146/17]
View answerThe LTI Scheme was established under Section 59(3) of the Health Act 1970 (as amended). The conditions covered by the LTI are: acute leukaemia; mental handicap; cerebral palsy; mental illness (in a person under 16); cystic fibrosis; multiple sclerosis; diabetes insipidus; muscular dystrophies; diabetes mellitus; parkinsonism; epilepsy; phenylketonuria; haemophilia; spina bifida; hydrocephalus; and conditions arising from the use of Thalidomide. Under the LTI Scheme, patients receive drugs, medicines, and medical and surgical appliances directly related to the treatment of their illness, free of charge.
There are no plans to extend the list of conditions covered by the Scheme.
167. Deputy Kevin O'Keeffe asked the Minister for Health if he will assist in having appropriate long-term care provided for a person (details supplied) in County Cork. [21169/17]
View answerAs this is a service matter, it has been referred to the Health Service Executive for direct reply.
168. Deputy Fergus O'Dowd asked the Minister for Health his plans to provide automatic medical cards for persons on long-term kidney dialysis treatment; and if he will make a statement on the matter. [21175/17]
View answerIn accordance with the provisions of the Health Act 1970 (as amended), eligibility for a medical card is determined by the HSE. The Act obliges the HSE to assess whether a person is unable, without due hardship, to arrange general practitioner services for himself or herself and his or her family, having regard to his or her overall financial position and reasonable expenditure and every application must be assessed on that basis. Under the legislation, having a particular illness, in itself, does not establish eligibility for a medical card and therefore, the medical conditions of applicants for this scheme are not monitored on that basis. Where the applicant's income is within the income guidelines, a medical card or GP visit card will be awarded.
It should be noted that every effort is made by the HSE, within the framework of the legislation, to support applicants in applying for a medical card and, in particular, to take full account of the difficult circumstances in the case of applicants who may be in excess of the income guidelines. Social and medical issues are considered when determining whether undue hardship exists for an individual accessing general practitioner or other medical services. The HSE affords applicants the opportunity to furnish supporting information and documentation to fully take account of all the relevant circumstances that may benefit them in the assessment, including medical evidence of cost and necessary expenses.
The HSE has a system in place for the provision of medical cards in response to an emergency situation for persons with a serious medical condition in need of urgent or on-going medical care that they cannot afford and persons in palliative care, who are terminally ill. With the exception of terminally ill patients, all medical cards, granted on an emergency basis, are issued on the basis that the patient is eligible for a medical card on the basis of means or undue hardship, and will follow up with a full application within a number of weeks of receiving the medical card eligibility. These cards are issued within 24 hours of receipt of the required patient details and a letter which confirms the medical condition from a doctor or consultant. For terminally ill persons, no means test applies and the cards are not renewed.
It is important that people with medical needs are able to access necessary assistance in a straight forward manner. It is clear greater discretion is being exercised by the HSE because the number of discretionary medical cards in circulation has increased from about 52,000 in mid-2014 to over 119,620 as of 1 April this year. This followed the measures announced by my predecessor Minister Varadkar, when the "Keane" Report of the Expert Panel on Medical Need for Medical Card Eligibility was published. The "Keane" Report found that it is not feasible, desirable or ethically justifiable to list medical conditions for medical card eligibility. On foot of the publication of the report, the HSE established a Clinical Advisory Group to develop clinical oversight and guidance for the operation of a more compassionate and trusted medical card system. Its establishment followed the completion of the work of the Expert Panel on Medical Need for Medical Card Eligibility and demonstrates the HSE's commitment to the development of a medical system which is responsive and considerate of an applicant's particular circumstances.
169. Deputy Fergus O'Dowd asked the Minister for Health if he will address the concerns raised in correspondence (details supplied) on Lyme disease; and if he will make a statement on the matter. [21176/17]
View answer188. Deputy Gerry Adams asked the Minister for Health the current HSE protocol for identifying Lyme disease; the treatment options; if Lyme disease is classified as a chronic disease; if consideration will be given to classifying it as such; and if he will make a statement on the matter. [21251/17]
View answer189. Deputy Gerry Adams asked the Minister for Health if his attention has been drawn to the German model of detecting Lyme disease; and if consideration will be given to introducing a similar model here. [21252/17]
View answer190. Deputy Gerry Adams asked the Minister for Health the number of persons with Lyme disease here; and if he will provide a breakdown of diagnoses of Lyme disease in each year for the past five years. [21253/17]
View answerI propose to take Questions Nos. 169 and 188 to 190, inclusive, together.
Lyme disease (also known as Lyme borrelliosis) is an infection caused by a spiral-shaped bacterium called Borrelia burgdorferi. It is transmitted to humans by bites from ticks infected with the bacteria. The infection is generally mild affecting only the skin but can occasionally be more severe and highly debilitating. Lyme Disease is the commonest cause of tick-borne infection in Europe.
In general, it is accepted clinical practice in Ireland, the UK, Europe and North America that laboratory confirmation is unnecessary for a confidently-made, clinical diagnosis of erythema migrans (the initial primary skin lesion of Lyme borrelliosis). For later presentation Lyme borrelliosis, the two-tier system is necessary to ensure that false-positive rates are kept to a minimum. Serological testing for antibodies to Borrelia burgdorferi is the mainstay of diagnostic testing. There have been significant improvements in antibody testing in recent years, making diagnosis more certain than in the past. Testing for Lyme borrelliosis is currently undertaken in most of the larger hospitals in Ireland. The standard approach to Lyme diagnostics is a two-stage process and involves using a sensitive enzyme immunoassay (EIA – a test to detect proteins found in the Borrelia bacterium) as an initial, screening step. Screening EIAs can be insufficiently specific, giving false-positive reactions (i.e. leading to over diagnosis) in the presence of other infections such as syphilis, and certain viral infections including glandular fever. In addition, false-positive results can also occur in patients with autoimmune disorders and other inflammatory conditions including, rheumatoid arthritis, scleroderma, diabetes or ulcerative colitis. Samples giving reactive or equivocal results in screening tests are further investigated in a second-stage, confirmatory immunoblot (such as Western blot) tests. Use of immunoblot testing greatly increases specificity (i.e. it reduces the likelihood of these false positive results). Using this two stage approach gives a considerably great degree of certainty around the diagnosis of Lyme. All clinical (and other) laboratories in Ireland, must undergo continuous quality assurance to ensure that the quality of the laboratory tests they provide is maintained at conform to the highest internationally-accepted standards.
The HSE-Health Protection Surveillance Centre has established a Lyme Borreliosis Sub-Committee with the primary aim to examine best practice in prevention and surveillance of Lyme Disease and to develop strategies to undertake primary prevention in order to minimise harm caused by Lyme Borreliosis in Ireland. This will involve raising awareness among clinicians and the general public. The initial work packages of the Lyme Borreliosis Sub-committee involves a survey of laboratory methods for the diagnosis of Lyme borreliosis in Ireland, the development of Lyme borreliosis guidance for general practitioners and the publication of medical media articles to highlight diagnostics and laboratory methods relating to Lyme borreliosis available in Ireland for general practitioners. It is intended that the Sub-Committee will publish a final report on its findings.
Lyme borelliosis was made been statutorily notifiable in Ireland by the Infectious Diseases (Amendment Regulations) Regulations 2011 (S.I. no 452 of 2011). The notifiable entity is Lyme neuroborreliosis, the more severe neurological form of Lyme borelliosis. The Health Protection Surveillance Centre (HPSC) of the HSE collects and collates surveillance data on notifiable infectious diseases. The number of annual neuroborreliosis notifications over the last few years is as follows:
- 2012 – 8 cases;
- 2013 – 13 cases;
- 2014 – 18 cases;
- 2015 – 12 cases;
- 2016 - 21 cases (provisional).
There is extensive information available on the HPSC website http://www.hpsc.ie/A-Z/Vectorborne/LymeDisease/ including extensive general information on Lyme disease, Information for Healthcare Professionals, illustrations showing the characteristic rash of erythema migrans and relative tick sizes, and a new set of FAQs to answer the commonest questions about Lyme testing. Since 2013, the HPSC has held an annual ‘Lyme Awareness Week’ at the beginning of the tick biting season, the purpose of which is to draw attention - particularly in the media - to Lyme disease and the ticks that can spread this disease. This year Lyme Disease week will take place on 15 - 22 May.
