Written Answers Nos. 474-496
474. Deputy Billy Kelleher asked the Minister for Health the reason a person (details supplied) has been unable to secure a registered right of way from the HSE on a road at which they have an existing right of way and have been using for the past 30 years; and if he will make a statement on the matter. [24292/17]
View answerYour question has been referred to the Health Service Executive for direct reply as the management of the healthcare property estate is a service matter.
475. Deputy Aengus Ó Snodaigh asked the Minister for Health if persons (details supplied) can be taken on as medical card patients at a surgery. [24293/17]
View answerAs this question relates to a service matter, I have arranged for the question to be referred to the Health Service Executive for direct reply.
476. Deputy Éamon Ó Cuív asked the Minister for Health the steps he is taking to ensure that there are sufficient occupational therapy services available to eliminate the waiting list for assessments for children in need of these services in the CHO west region; and if he will make a statement on the matter. [24296/17]
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.
477. Deputy Michael Fitzmaurice asked the Minister for Health the reason there are no staff at Beaumont Hospital to administer DHE treatment; if this is the case in view of the fact that there are persons waiting up to two years for treatment; and if he will make a statement on the matter. [24300/17]
View answerI acknowledge that waiting times are often unacceptably long and I am conscious of the impact of this on people’s lives. Reducing waiting times for the longest waiting patients is one of this Government's key priorities.
The National Clinical Programme for Neurology (NCPN) Model of Care document recommends an increase in the number of consultant neurologists, nurse specialists, including clinical nurse specialists, and other health care professionals which would address waiting time issues. The programme also proposed implementation of these recommendations over a period of 5 years. This will significantly improve the access for all Neurology patients.
The Model of Care was launched by the Director General of the HSE on the 27 September 2016 and the HSE is now working towards its implementation.
In response to the particular query raised, as this is a service matter, I have asked the HSE to respond to you directly.
478. Deputy Imelda Munster asked the Minister for Health further to Parliamentary Question No. 809 of 2 May 2017 and further to the response received from the HSE on 10 May 2017, if the Louth Meath constituency area CHO8 schedules part 2 in relation to St. John of Gods is signed or unsigned; if it is unsigned, the reason schedules would remain unsigned in view of the level of funding involved; the value the 20% of funding withheld amounts to in circumstances in which the schedules remain unsigned; the actions being taken to ensure remaining schedules are signed by the end of 2017; and if he will make a statement on the matter. [24304/17]
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 service matters, I have arranged for the question to be referred to the Health Service Executive (HSE) for direct reply to the Deputy.
479. Deputy Timmy Dooley asked the Minister for Health when a person (details supplied) will be given an appointment to be assessed for treatment; and if he will make a statement on the matter. [24306/17]
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.
480. Deputy John Brady asked the Minister for Health when the HSE physiotherapy clinic will open in a location (details supplied); and if he will make a statement on the matter. [24308/17]
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.
481. Deputy Peadar Tóibín asked the Minister for Health his plans to produce a funded care path for persons who are suffering from Lyme disease (details supplied). [24310/17]
View answerLyme disease (also known as Lyme borreliosis) 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 Health Protection Surveillance Centre (HPSC) of the HSE has extensive information concerning Lyme disease on its website www.hpsc.ie/a-z/vectorborne/lymedisease/.
Lyme disease is diagnosed by medical history and physical examination. The infection is confirmed by blood tests which look for antibodies produced by an infected person's body in response to the infection. These normally take several weeks to develop and may not be present in the early stages of the disease. The standard approach to Lyme diagnostics is a two-stage approach and involves using a sensitive enzyme immunoassay (EIA) as an initial, screening step. Screening EIAs can be insufficiently specific, giving false-positive reactions in the presence of other similar bacteria, and certain other viral infections, including glandular fever. In addition, blood samples from patients with autoimmune disorders and other inflammatory conditions can also lead to false-positive results. Samples giving positive or equivocal results in screening tests are further investigated in a second-stage immunoblot (Western blot) tests. Use of immunoblot testing greatly increases specificity. Using this two stage approach will give a 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 diagnostics they provide is maintained at the highest international level for human diagnostics. Some laboratories abroad do not use antibody tests like the EIA (screening ELISA test) and Western Blot and instead will use other types of tests, for example, testing for levels of a specific white blood cell (CD-57) or lymphocyte transformation tests (tests to measure how specific cells in a person's immune system respond when exposed to antigens against Borrelia burgdorferi - the bacterium responsible for Lyme disease). These types of tests are not currently recommended by international groups such as the CDC, Infectious Diseases Society of America (IDSA) or BIA for a number of reasons:
I. There is not enough scientific evidence that they are suitable tests to diagnose Lyme disease;
II. There is no standard method to perform and interpret these kind of tests; and
III. Positive results in these kinds of tests may be due to other illnesses or conditions and not just Borrelia infection.
Lyme disease can be very successfully treated using common antibiotics. These antibiotics are effective at clearing the rash and helping to prevent the development of complications. Antibiotics are generally given for up to three weeks. If complications develop, intravenous antibiotics may be considered.
In Ireland, treatment by most clinicians is based on that laid out in evidence-based guidelines for the management of patients with Lyme disease, human granulocytic anaplasmosis (formerly known as human granulocytic ehrlichiosis), and babesiosis published by the Infectious Diseases Society of America (IDSA) in 2006. This pharmacological regime can be summarised thus:
- Doxycycline, amoxicillin or cefuroxime for the treatment of adults with early localised or early disseminated Lyme disease associated with erythema migrans, in the absence of specific neurologic manifestations (ceftriaxone in early Lyme disease for adults with acute neurologic disease manifested by meningitis or radiculopathy);
- Doxycycline, amoxicillin, or cefuroxime for adults with Lyme arthritis but without clinical evidence of neurologic disease;
- For late neurological disease in adults - intravenous ceftriaxone, cefotaxime or Penicillin G.
There is significant support and information for health professionals on the HPSC website. These supports include a fact sheet on tick borne diseases, including Lyme Disease. This fact sheet gives information on clinical features, the disease, transmission routes, prevention measures, diagnosis, and management and treatment. There is also an erythema migrans (EM) diagnostic tool to aid health professionals in the diagnosis of EM, which is frequently the earliest clinical manifestation of Lyme borreliosis.
As testing and treatment for Lyme borreliosis is widely available in Ireland there is no requirement for people to travel to other EU Member States to access these services.
482. Deputy Caoimhghín Ó Caoláin asked the Minister for Health further to Parliamentary Question No. 791 of 2 May 2017, the level of ongoing engagement with the social care division to optimise timely access to homecare packages; the areas that have been identified within this area as being problematic or are barriers to expansion of early supported discharge; the actions which will be taken to ensure access to homecare packages for stroke patients or those suitable for ESD; and if he will make a statement on the matter. [24314/17]
View answer485. Deputy Caoimhghín Ó Caoláin asked the Minister for Health if the provision of homecare packages will be broadened to include persons under 65 years of age; the consideration which has been given to this in discussions between the national stroke programme and the social care division; and if he will make a statement on the matter. [24317/17]
View answer486. Deputy Caoimhghín Ó Caoláin asked the Minister for Health further to Parliamentary Question No. 1072 of 2 May 2017, if his attention has been drawn to the fact that increased difficulty in accessing home care support is worse for persons under 65 years of age who have suffered a stroke; the consideration which is being given to those persons to access home supports in order to avoid direct discharge to nursing homes, the increase in which has translated to additional expenditure of €17.25 million between 2014 and 2015; and if he will make a statement on the matter. [24318/17]
View answer487. Deputy Caoimhghín Ó Caoláin asked the Minister for Health further to Parliamentary Question No. 793 of 2 May 2017, the enhanced number of persons who could access early supported discharge if there was prompt access to home-care packages; the number of persons have been unable to access ESD specifically due to a lack of access to ESD; the areas in which this has been an issue; and if he will make a statement on the matter. [24319/17]
View answerI propose to take Questions Nos. 482 and 485 to 487, inclusive, together.
Home care services are critical to allow older people to stay in their own homes for as long as possible. They can also provide respite to carers and support them in their caring role. The HSE provides Home Care Packages which are enhanced supports, over and above existing mainstream Home Help service and can include additional home help hours, nursing services, therapy services that might be needed due to illness, disability or after a stay in hospital or following rehabilitation in a nursing home. Access to HCPs is provided on the basis of assessed care need, carried out by health care professionals and there is no means test.
In 2014, the HSE introduced Intensive Home Care Packages to facilitate timely discharge home from acute hospitals of people who require very significant interventions to an extent not previously provided as part of the Home Care Package Scheme or current community services. This year the HSE will provide 190 such packages.
If a younger person’s assessed needs can be best met by services designed for older people then occasionally such an application may be considered, however access to home care packages by reference to illness type is not provided.
I would like to remind the Deputy that the Department of Health is currently engaged in a detailed process to design a new system of regulation for these important services. This process will also determine the type of scheme that will apply to home care. As an initial step, 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.
The National Clinical Programme for Stroke has been in place since early 2010. The vision of the programme is to design standardised models of integrated care pathways for the delivery of clinical care. Early Supported Discharge is a rehabilitation programme that aims to accelerate discharge home from hospital and provide rehabilitation and support in the home setting in order to maximise independence as quickly as possible after stroke. Pilot Early Supported Discharge programmes in three sites in Ireland have proved to be effective, with up to 35% of stroke patients being discharged successfully.
The HSE has advised the Department that its Integrated Care Programme for Patient Flow has identified the need to strengthen the integrated patient-centred approach. Improving discharge processes is not only necessary to deliver safe and truly person-centred care but also to optimise bed utilisation.
Funding has been allocated by the Clinical Strategy and Programmes Division to the Integrated Care Programme for Patient Flow to support the National Clinical Programme for Stroke to expand the Early Support Discharge Stroke Programme in 2017. This involves increasing staffing in three existing Early Supported Discharge Stroke teams and developing two new teams at a full year cost of €460,051.
Early supported discharge complements the range of measures to improve stroke care including 24/7 access to thrombolysis and increasing the number of stroke units to twenty-two. These measures have reduced stroke mortality, reduced average length of stay in hospital and enabled more stroke patients to be discharged directly to home.
I have asked the HSE to address the operational matters of the Deputy’s Question.
483. Deputy Caoimhghín Ó Caoláin asked the Minister for Health further to Parliamentary Question No. 1071 of 2 May 2017, the cost of increasing the number of stroke unit beds to meet the predicted increase of stroke numbers; the further cost of bringing stroke units to quality standards; and if he will make a statement on the matter. [24315/17]
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.
484. Deputy Caoimhghín Ó Caoláin asked the Minister for Health the number of applications for home care packages that were submitted by persons under 65 years of age in 2015 and 2016; the number of these applications which were successful; and if he will make a statement on the matter. [24316/17]
View answerAs this is a service matter it has been referred to the Health Service Executive for direct reply.
488. Deputy Caoimhghín Ó Caoláin asked the Minister for Health further to Parliamentary Question No. 793 of 2 May 2017, the staffing vacancies that currently exist in the early supported discharge teams across the current sites; and if he will make a statement on the matter. [24320/17]
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.
489. Deputy Caoimhghín Ó Caoláin asked the Minister for Health further to Parliamentary Question No. 793 of 2 May 2017, the challenges that exist in respect of the staffing in maintaining early supported discharge teams across the current sites; the challenges that exist in respect of the organisation, for example, catchment areas in maintaining early supported discharge teams across the current sites; and if he will make a statement on the matter. [24321/17]
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.
490. Deputy Caoimhghín Ó Caoláin asked the Minister for Health if his attention has been drawn to the findings of a report (details supplied); if there will be a multi-year plan put in place to address the service and staff deficits in stroke services here; and if he will make a statement on the matter. [24322/17]
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.
491. Deputy Caoimhghín Ó Caoláin asked the Minister for Health if he will meet representatives of an organisation (details supplied) that has requested a meeting on stroke services here in view of the findings of a report; and if he will make a statement on the matter. [24323/17]
View answerMy office will arrange for a meeting with the Irish Heart Foundation as soon as it is practicable.
492. Deputy Alan Kelly asked the Minister for Health the evidence by which the legislation was concluded for guidelines (details supplied) to exist around vaping products under the TPD, in view of the fact they are not a tobacco product; and the assistance an organisation (details supplied) or retailers can give to the Departments to help bring about effective and relevant legislation regarding the products provided by providers. [24326/17]
View answer507. Deputy Alan Kelly asked the Minister for Health the evidence used as the basis for the guidelines for vaping products in the Tobacco Product Directive 2014/14/EU, in view of the fact they are not a tobacco product; and the assistance that the IVVA and retailers can provide to Government to bring about effective and relevant legislation for these products. [24484/17]
View answerI propose to take Questions Nos. 492 and 507 together.
The EU Tobacco Products Directive 2014/14/EU introduced new rules for tobacco products and for nicotine-containing e-cigarettes and refill containers. The EU Commission indicated that as nicotine is an addictive and toxic substance, safety and quality requirements for nicotine-containing e-cigarettes were necessary. Reporting obligations were also needed so that public authorities could monitor and learn more about these products.
A proposal for a new Tobacco Products Directive was adopted and published by the EU Commission in 2012 following extensive consultation of stakeholders, including a public consultation which generated 85,000 responses. During the proposal's preparation, an extensive impact assessment was carried out by the EU Commission evaluating economic, social and health effects of several policy options under consideration and several external studies were commissioned during the process. The 2012 proposal was then discussed in the European Parliament and in the Council of Ministers and was formally adopted as a Directive in 2014.
As a Member of the EU Ireland was obliged to transpose this Directive into Irish law. These new rules were transposed by the European Union (Manufacture, Presentation and Sale of Tobacco and Related Products) Regulations 2016 (S.I. No. 271 of 2016) and subject to Regulation 47 (transitional provisions), have been effective from 20th May 2016. The guidelines mentioned by the Deputy refer to a number of guidance documents issued to assist manufacturers, importers, distributors and retailers of e-cigarettes or refill containers to comply with this new legislation.
493. Deputy Mary Butler asked the Minister for Health the position regarding the provision timeline for the mobile catheterisation laboratory at University Hospital Waterford as announced by the Minister of State, Deputy Halligan, on 13 January 2017; when it will be on site; the length of time it will be on site; the number of hours per week it will be operable; and if he will make a statement on the matter. [24330/17]
View answer519. Deputy Mary Butler asked the Minister for Health when the terms of reference will be decided for the next clinical review of cardiac care in the south east, based at University Hospital Waterford. [24553/17]
View answer520. Deputy Mary Butler asked the Minister for Health if PPCI intervention services are under threat at University Hospital Waterford. [24533/17]
View answer521. Deputy Mary Butler asked the Minister for Health the status of waiting lists for PPCI intervention at University Hospital Waterford. [24534/17]
View answer522. Deputy Bobby Aylward asked the Minister for Health the cost of the daily running of the mobile catheterisation laboratory for the south east (details supplied); when the mobile catheterisation laboratory will be fully operational; and if he will make a statement on the matter. [24572/17]
View answerI propose to take Questions Nos. 493, and 519 to 522, inclusive, together.
The Deputy will be aware that in his review of cath lab services in University Hospital Waterford (UHW), Dr Niall Herity recommended that the UHW cath lab should operate as an elective lab which provides all specialised cardiac services except interventional treatment for patients who are having heart attacks (PPCI). Dr. Herity also recommended that the current 9 to 5 provision of these emergency services should cease in order to allow the hospital to focus on the much larger volume of planned cath lab work. In addition, investment was recommended to enable the hospital to provide additional cath lab capacity. In that regard, additional funding of €0.5m has been provided to UHW in 2017.
In relation to the cessation of PPCI services at the hospital, as Minister for Health, I want to be sure that any service changes which we implement, will result in improved services for patients using that service. Therefore, I have asked my Department to address the implications of this recommendation by undertaking a national review of all PPCI services with the aim to ensure that as many patients as possible have access, on a 24/7 basis, to safe and sustainable emergency interventions following a heart attack. Terms of Reference for that review have not yet been drafted. In the meantime, patients in the South East will continue to have access to out of hours PPCI services at Cork University Hospital (CUH) or St James's Hospital, Dublin.
Given the emergency nature of PPCI services, there are no waiting lists for such treatment. In respect of scheduled cardiology services at UHW, the HSE has advised that, following a targeted initiative, all patients who, in December 2016, were waiting over 3 months for an in-patient/day case cardiology procedure at UHW will have been seen in CUH/UHW by the end of June 2017. According to April 2017 NTPF data, a total of 380 patients are waiting for a cardiology in-patient/day case procedure at UHW, with 224 of those waiting less than 3 months. To continue this excellent progress, I have asked the HSE to maximise the benefit for patients from the additional €0.5m funding provided to UHW this year, in respect of both additional sessions at the existing cath lab and the temporary use of a mobile cath lab for a specific period. I expect further details on this to be available shortly.
494. Deputy Thomas P. Broughan asked the Minister for Health the estimated amount it would cost to reduce the monthly limit of the drugs payment scheme from €144 to €125; and if he will make a statement on the matter. [24401/17]
View answerUnder the Health (Pricing and Supply of Medical Goods) Act 2013, the HSE has statutory responsibility for the administration of the community drug schemes; therefore, the matter has been referred to the HSE for attention and direct reply to the Deputy.
495. Deputy Thomas P. Broughan asked the Minister for Health the way in which the extra €6.8 million allocated to maternity services in 2017 will be spent; and if he will make a statement on the matter. [24402/17]
View answer€3 million development funding provided for maternity services in 2016 was allocated in line with Ireland's first National Maternity Strategy - Creating A Better Future Together 2016 - 2026. It included funding for additional staff, including 100 midwives, the development of specialist bereavement teams and for the implementation of the Maternal and Newborn Clinical Management System. Increased funding of €6.8m has been provided for maternity services in 2017 to allow for the continued implementation of the Strategy. I have asked the HSE to provide you with further detail on its allocation.
496. Deputy Thomas Pringle asked the Minister for Health the status of the scheme to replace the motorised transport grant; the expected date for its implementation; and if he will make a statement on the matter. [24406/17]
View answerConscious of the reports of the Ombudsman in 2011 and 2012 regarding the legal status of both the Mobility Allowance and Motorised Transport Grant Scheme in the context of the Equal Status Acts, the Government decided to close both schemes in February 2013.
However, monthly payments of up to €208.50 have continued to be made by the Health Service Executive to 4,700 people who were in receipt of the Mobility Allowance.
The Government decided that the detailed preparatory work required for a new Transport Support Scheme and associated statutory provisions should be progressed by the Minister for Health and the Programme for a Partnership Government acknowledges the ongoing drafting of primary legislation for a new Transport Support Scheme. I can confirm that work on the policy proposals for the new Scheme is at an advanced stage. The proposals seek to ensure that:
- There is a firm statutory basis to the Scheme's operation;
- There is transparency and equity in the eligibility criteria attaching to the Scheme;
- Resources are targeted at those with greatest needs; and
- The Scheme is capable of being costed and is affordable on its introduction and on an ongoing basis.
The next step is to seek Government approval to the drafting of a Bill for the new Scheme.
The Deputy may be interested to note that people who previously benefitted from the now-closed Motorised Transport Grant, may, if they satisfy the criteria under that Scheme, be eligible for tax relief under the Drivers and Passengers with Disabilities Tax Relief Scheme. This Scheme is the responsibility of my colleague, the Minister for Finance and is operated by the Revenue Commissioners. Details of the scheme can be found on www.revenue.ie.
