Written Answers Nos. 402-423
402. Deputy Aindrias Moynihan asked the Minister for Health the regulations in place for approving vaping products; the time it takes to approve a product for sale here; and the stages it goes through for approval. [31236/17]
View answerThe Tobacco Products Directive 2014/40/EU ('the Directive') was transposed into Irish law by the European Union (Manufacture, Presentation and Sale of Tobacco and Related Products) Regulations 2016 (S.I. No. 271 of 2016). These Regulations were subsequently amended by the European Union (Manufacture, Presentation and Sale of Tobacco and Related Products) (Amendment) Regulations 2017 (S.I. No. 252 of 2017) in order to transpose EU Commission Implementing Act related to the Directive. In addition certain sections of the Public Health (Standardised Packaging of Tobacco) Act 2015 transposed in part Articles 13 and 14 of the Directive.
In line with the Directive, the Regulations provide that manufacturers and importers of electronic cigarettes and refill containers must notify the Health Service Executive, the competent authority, 6 months prior to placing products on the market.
The notifications, which are submitted through an EU common entry gateway, must include information on the manufacturer and/or importer, ingredients used and emissions, nicotine dose and uptake, the production process and a declaration that the manufacturer and/or importer takes full responsibility for the quality and safety of the product under normal use. Manufacturers and importers of electronic cigarettes and refill containers must also report annually on sales volumes, consumer preferences and trends.
The competent authority does not approve the products for sale. It is a matter for each manufacturer or importer to ensure that his/her products comply with the relevant provisions of the Regulations.
403. Deputy Anne Rabbitte asked the Minister for Health the number of children awaiting the allocation of an appointment time from CAMHS, child and adolescent mental health service, by age group (details supplied) and by county; and if he will make a statement on the matter. [31250/17]
View answerAs this is a service issue, this question has been referred to the HSE for direct reply.
404. Deputy Micheál Martin asked the Minister for Health the diagnostic facilities available to public patients to test for Lyme disease; his plans to make it more freely available; if his Department is examining this issue; if the Chief Medical Officer has issued guidelines regarding adequate tests being available; if he is satisfied that public patients are receiving adequate access to diagnostics; his views regarding tests being carried out abroad; and if he will make a statement on the matter. [31254/17]
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 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 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 - 08 cases;
- 2013 - 13 cases;
- 2014 - 18 cases;
- 2015 - 12 cases;
- 2016 - 21 cases (provisional).
The Scientific Advisory Committee of the HPSC, the Infectious Diseases Society of Ireland, the Irish Society of Clinical Microbiologists, the Irish Institute of Clinical Neuroscience and the Irish College of General Practitioners agreed a Consensus Statement on the Clinical Management of Lyme Borreliosis, which endorsed the previously referenced, internationally recognised set of guidelines (those of the IDSA) to Medical Practitioners to ensure a standardised approach to the diagnosis and management of Lyme disease in Ireland.
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.
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. 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.
The Scientific Advisory Committee of the HPSC has established a Lyme Borreliosis Sub-Committee, the aim of which is to develop strategies to undertake primary prevention in order to minimise the harm caused by Lyme Borreliosis in Ireland. In addition to staff from the HPSC, the membership of the Sub-Committee includes specialists in Public Health Medicine, Consultants in Infectious Diseases, Clinical Microbiology, Occupational Health an Entomologist from the Parks and Wildlife Service, a representative from the Local Government Management Agency, an Environmental Health Officer and, very importantly, a representative from Tick Talk Ireland, the primary Support Group for Lyme disease in Ireland. The Sub-Committee first met on 6 May 2015 and it is expected to report in 2017.
There is significant support and extensive information for health professionals and the public 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. Information for the public includes:
- Lyme Disease Frequently Asked Questions;
- Laboratory testing for Lyme Disease: FAQs for general public;
- Lyme Disease Illustrations; and
- CDC's instructions on how to remove a tick.
Testing for Lyme borrelliosis is currently undertaken in most of the larger hospitals in Ireland. 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.
405. Deputy Joan Burton asked the Minister for Health if there is a senior official with designated responsibility for Brexit matters in his Department; if so, the grade of the designated official; the funding allocated to the said Brexit unit; the cost to date in 2017; the anticipated cost; and if he will make a statement on the matter. [31275/17]
View answerThe Deputy Secretary General, Policy and Strategy Division, and the Assistant Secretary, R&D and Health Analytics Division, are the lead officials in my Department for planning and co-ordination on Brexit matters. The Department of Health participates fully in the Senior Officials Group on EU Affairs, the Interdepartmental Group on EU/UK Affairs, and its workgroups established to support the Cabinet Committee on Brexit.
The Department established a Management Board Subcommittee on Brexit in advance of the UK referendum, to examine the implications of a decision to leave the EU. The Subcommittee is chaired at senior level and made up of representatives from across the Department, as well as from the HSE, which is represented at National Director level. The Subcommittee reports to the Management Board on Brexit. In addition to the Management Board Subcommittee, an Interdepartmental/Interagency Group, chaired by the Assistant Secretary of the Primary Care Division, has been established to prepare a bid for the relocation of the European Medicines Agency on foot of a Government Decision at the end of October 2016.
Brexit raises many issues across a wide range of areas that need to be addressed. Work on each specific issue will be led by the line Units with policy responsibility. Units have built up the necessary expertise and contacts with their UK and EU counterparts over time to enable them to examine and address the implications of Brexit in their area. In this way, work on Brexit-related issues is being mainstreamed throughout the Department.
Within my Department, International and Research Policy Unit provides a coordinating function in relation to Brexit just as it does for other international matters and North-South cooperation. The Department has a full-time EU health attaché stationed in the Permanent Representation in Brussels, who is in regular contact with International and Research Policy Unit and other Units throughout the Department. Resources allocated to Brexit in my Department are kept under ongoing review.
406. Deputy Billy Kelleher asked the Minister for Health if recognition and support will be given to a group (details supplied); and if he will make a statement on the matter. [31290/17]
View answer407. Deputy Billy Kelleher asked the Minister for Health his plans to establish a national support phone service for a group (details supplied) to ensure it has access to an independent confidential and listening service; and if he will make a statement on the matter. [31291/17]
View answerI propose to take Questions Nos. 406 and 407 together.
I am advised that many of the individuals for whom support is sought by the Group to which the Deputy refers have been awarded Health Amendment Act (HAA) Cards. Holders of HAA Cards have access to a very broad range of entitlements, including GP services, home nursing, home support (cleaning, childcare etc.), hospital services, treatment and appliances, pharmacy, physiotherapy, chiropody/podiatry, counselling and ophthalmic services, dental treatment and complementary therapies.
The National Hepatitis C Co-ordinator in the HSE is in ongoing communication with representatives of this Group.
Assistance has been provided to this Group as follows:
- facilitation of meetings involving the group and the National Hepatitis C Co-ordinator;
- use of HSE meeting rooms; and
- use of HSE printing, photocopying, postage and stationery facilities.
408. Deputy Billy Kelleher asked the Minister for Health the date by which he will amend the statutory instrument regarding membership of the consultative council on hepatitis C to allow for women who have been infected with hepatitis C through the contaminated blood product anti-d immunoglobulin to be represented; and if he will make a statement on the matter. [31292/17]
View answer409. Deputy Billy Kelleher asked the Minister for Health the date by which he will advertise the vacant positions on the consultative council on hepatitis C to be filled by a group (details supplied); his views on whether the exclusion of the largest infected group among those recognised as State infected to appointments made to the consultative council on hepatitis C is unfair and undemocratic; and if he will make a statement on the matter. [31293/17]
View answerI propose to take Questions Nos. 408 and 409 together.
My Department is currently progressing the amendment of section 5 of S.I. No. 339 of 1996 - The Consultative Council on Hepatitis C (Establishment) Order, 1996. This amendment will provide for the Consultative Council to include representation of those who contracted Hepatitis C through the administration of Anti-D Immunoglobulin in the State. Officials of my Department are working with the Office of the Attorney General in this regard.
410. Deputy Patrick O'Donovan asked the Minister for Health if his Department has provisions in place to encourage Irish graduate doctors to remain and work in rural areas; and if he will make a statement on the matter. [31294/17]
View answerI am aware that there are difficulties in filling some medical positions in rural locations, encompassing hospital and some GP posts.
In July 2013, the Minister for Health established a Working Group to make high-level recommendations relating to training and career pathways for doctors. The Group noted current challenges in respect of staffing of particular consultant-level posts and the onerous out-of-hours commitment and demanding rotas in some smaller hospitals. The Group considered that the reconfiguration of services in the context of the Hospital Groups provided an opportunity to address this issue. The establishment of Hospital Groups is a key enabler for reorganisation of services across hospitals. Significant progress has been made in the implementation of Hospital Groups, with more co-ordinated approaches to the planning and delivery of services across all the hospitals within a Group. Hospitals are now working together to support each other, providing a stronger role for smaller hospitals in delivering less complex care and ensuring that patients who require true emergency or complex planned care are managed safely in larger hospitals. The potential for improved workforce organisation, as part of addressing the staffing challenges in some hospitals, is a key aspect of the continued development of Hospital Groups.
The Government is committed to the continued development of GP capacity to ensure that patients across the country continue to have access to GP services, especially in remote rural areas and also in disadvantaged urban areas, and that general practice is sustainable in all areas into the future. I want to ensure that existing GP services are retained and that general practice remains an attractive career option for newly qualified GPs. Several efforts to increase the number of practising GPs have been undertaken in recent years. These include increases in the number of GP training places, which have risen from 120 places in 2009 to 171 places being formally accepted for the 2017 training intake as of 13 June, representing an increase of 43% in the last 8 years. Changes have been made to the entry provisions to the GMS scheme to facilitate more flexible/shared GMS contracts, and to the retirement provisions for GPs under the GMS scheme.
An enhanced supports package for rural GP practices was also introduced in May 2016. The new Rural Practice Support Framework includes improved qualifying criteria for rural support and an increase in the financial allowance from €16,216 to €20,000 per annum. Over 300 GPs now benefit from rural practice supports under this Framework. This is a significant increase on the 167 GPs who received the Rural Practice Allowance prior to the introduction of the new Framework last year. In addition, the GP contracts review process which is currently underway will seek to arrive at contractual arrangements which will ensure that general practice is an attractive, fulfilling and rewarding career option into the future.
411. Deputy Patrick O'Donovan asked the Minister for Health his plans to replace the 11 general practitioners who will be retiring in west Limerick over the next five years; and if he will make a statement on the matter. [31295/17]
View answerAs this question relates to service matters, I have arranged for the question to be referred to the Health Service Executive for direct reply.
412. Deputy Patrick O'Donovan asked the Minister for Health his plans to review the contracts of GMS general practitioners; and if he will make a statement on the matter. [31296/17]
View answerThe development of primary care is central to the Government's objective to deliver a high-quality, integrated and cost effective health service. The Programme for Government commits to a decisive shift within the health service towards primary care in order to deliver better care close to home in communities across the country. The development of a new, modernised contract for the provision of general practitioner services will be a key element in facilitating this process.
The aim is to develop a contract which will facilitate the shift within the health service away from hospital services towards an integrated primary care service in order to deliver better care close to home in communities across the country. I want to see a new contract which has a population health focus, providing in particular for health promotion and disease prevention and for the structured ongoing care of chronic conditions. A new contract should be flexible and be able to respond to the changing nature of the GP workforce. It should also include provisions in relation to service quality and standards, performance, accountability and transparency. I think this will be key in making general practice a more attractive career.
Since 2015, negotiations have resulted in a number of service developments including the provision of free GP care to under 6's and over 70's, the introduction of a Diabetes Cycle of Care for adult GMS patients with Type 2 Diabetes and enhanced supports for rural GPs. The next phase of discussions on a new GP contract is under way. The discussions taking place are wide ranging and ambitious in their scope. While there will be challenges for all parties involved, I am hopeful that with the goodwill and cooperation of all parties, significant progress can be made in these discussions in the months ahead.
413. Deputy Andrew Doyle asked the Minister for Health if he will expedite surgery for a person (details supplied); his plans to address a situation regarding the lack of beds in the intensive care unit at St. James's Hospital for cardiology patients; and his further plans to open up private hospitals to public patients to help address the waiting lists for cardiology surgery at the hospital [31301/17]
View answerReducing waiting times for the longest waiting patients is one of the Government's key priorities. It is for this reason that €20 million was allocated to the National Treatment Purchase Fund (NTPF), rising to €55 million in 2018. In order to reduce the numbers of long-waiting patients, I asked the HSE to develop Waiting List Action Plans for 2017 in the areas of Inpatient/Daycase, Scoliosis and Outpatient services. These plans have been published and their implementation is ongoing.
The Inpatient/Daycase and Outpatient Plans focus on reducing the number of patients waiting 15 months or more for inpatient and daycase treatment or for an outpatient appointment by the end of October. Under these plans over 14,700 patients have come off Inpatient/ Daycase waiting lists, and over 51,000 patients have come off the Outpatient waiting list, and 148 scoliosis surgeries have taken place. The Department of Health will continue to work with the HSE and the NTPF to ensure the best use of public hospital capacity and the private hospital system to meet the needs of patients waiting for Inpatient, Daycase and Outpatient Services.
Regarding capacity at St James's Hospital, all proposals to extend intensive care facilities will need to be considered in the context of competing priorities in the 2018 Estimates process.
Under 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. In relation to the particular query raised about access to surgery for an individual patient, as this is a service matter, I have asked the HSE to respond to you directly.
414. Deputy John Brassil asked the Minister for Health the status of the provision of a nurse for a school (details supplied) in County Kerry; if funds have been sanctioned for this resource; if not, if he will request the HSE to do so; and if he will make a statement on the matter. [31308/17]
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.
The particular issue raised by the Deputy is a service matter for the HSE. Accordingly I have arranged for the question to be referred to the Health Service Executive (HSE) for direct reply to the Deputy.
415. Deputy Bernard J. Durkan asked the Minister for Health the status of the implementation of the next phase of the Naas hospital development plan with particular reference to the endoscopy unit and the Lakeview unit; the extent to which the expenditure in question will ensure the adequacy of the services required at Naas General Hospital and its catchment area including the full utilisation of theatre space and bed requirements; and if he will make a statement on the matter. [31310/17]
View answerI can confirm that the Department has forwarded its submission under the mid-term review of the capital programme to the Department of Public Expenditure and Reform. The submission is based on the projected funding requirement arising from exiting commitments, strategies, demand led service needs and commitments contained in the Programme for Partnership Government. At this stage in the process it is not proposed to specify the individual project details contained in the Department's submission.
As with all healthcare projects, including this project, further investment in hospitals must be considered within the overall acute hospital sector infrastructure programme, the prioritised needs of the hospital groups and within the overall capital envelope available to the health service. The HSE will continue to apply the available funding for infrastructure development in the most effective way possible to meet current and future needs, having regard to the level of commitments and the costs to completion already in place.
416. Deputy Louise O'Reilly asked the Minister for Health the number of times surgeries have been cancelled or have been disrupted or stopped due to a lack of equipment or equipment failure for each year since 2010; and if he will make a statement on the matter. [31311/17]
View answerIn response to the particular query raised, as this is a service matter, I have asked the HSE to respond to you directly.
417. Deputy Louise O'Reilly asked the Minister for Health the number of times surgeries have been cancelled or have been disrupted or stopped due to a lack of theatre staff in each year since 2010; and if he will make a statement on the matter. [31312/17]
View answerIn response to the particular query raised, as this is a service matter, I have asked the HSE to respond to you directly.
418. Deputy Louise O'Reilly asked the Minister for Health the number of times an on duty ambulance, rapid response vehicle or intermediate care vehicle has been involved in an accident while on duty in each year since 2010; and if he will make a statement on the matter. [31313/17]
View answerAs this is a service matter, I have asked the HSE to respond to you directly.
419. Deputy Louise O'Reilly asked the Minister for Health the number of times an on duty ambulance, rapid response vehicle or intermediate care vehicle has experienced mechanical difficulties while on duty including ambulance, rapid response vehicle or intermediate care vehicle that are on duty but cannot leave their starting location due to mechanical difficulties and had to be removed from duty as a result in each year since 2010; and if he will make a statement on the matter. [31314/17]
View answerAs this is a service matter, I have asked the HSE to respond to you directly.
420. Deputy Louise O'Reilly asked the Minister for Health the number of ambulances, rapid response vehicles and intermediate care vehicles that have been fitted with internal fire extinguishers; and if he will make a statement on the matter. [31315/17]
View answerAs this is a service matter, I have asked the HSE to respond to you directly.
421. Deputy Louise O'Reilly asked the Minister for Health the number of ambulances, rapid response vehicles and intermediate care vehicles that have been fitted with satellite navigation systems; and if he will make a statement on the matter. [31316/17]
View answerAs this is a service matter, I have asked the HSE to respond to you directly.
422. Deputy Louise O'Reilly asked the Minister for Health the number of times a doctor not on the Medical Council’s specialist register and who does not hold specialist division registration and, therefore, does not meet required qualification requirements including consultants appointed prior to March 2008 who did not have to meet that requirement on appointment but are operating as consultants have had a complaint lodged with the Medical Council regarding their performance; the nature of the complaint; the outcome of the complaint; and if he will make a statement on the matter. [31317/17]
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 if consideration is being given to producing guidelines for staff in accident and emergency departments for dealing with persons with narcolepsy; and if he will make a statement on the matter. [31318/17]
View answerIn response to the particular query raised, as this is a service matter, I have asked the HSE to respond to you directly.
