Written Answers Nos. 303-321
303. Deputy Catherine Connolly asked the Minister for Health further to Parliamentary Question No. 1077 of 11 September 2017, the anticipated role and function of the existing professional bodies for counselling and psychotherapy in relation to the accreditation of practitioners once the statutory registration board has been put in place in 2018; and if he will make a statement on the matter. [41300/17]
View answerWhile there is no formal role under the Act for professional bodies in the regulation of the relevant professions, stakeholders, including such bodies, are often consulted by the registration boards and the Health and Social Professionals Council on relevant issues.
304. Deputy Shane Cassells asked the Minister for Health if Versatis medicated plasters will remain as a reimbursable item under the medical card or drugs payment schemes; and if he will make a statement on the matter. [41304/17]
View answer315. Deputy Eoin Ó Broin asked the Minister for Health the reason lidocaine pain relief patches have been removed from the list of medicines available under the medical card; when this decision was taken; the evidence used to support this decision; the number of persons affected by this decision; the expected savings arising from this decision; and if the decision can be reconsidered for persons in view of the fact that they will not be able to afford this vital pain relief from their own resources [41339/17]
View answer321. Deputy John Curran asked the Minister for Health if he or the HSE have recently restricted the uses for which lidocaine patches can be prescribed for medical card holders; and if he will make a statement on the matter. [41393/17]
View answerI propose to take Questions Nos. 304, 315 and 321 together.
Medicines play a vital role in improving the overall health of Irish patients. Securing access to existing and new and innovative medicines, is a key objective of the Irish health service. However, the challenge is to deliver this objective in an affordable and sustainable manner. The medicines bill for the community drugs schemes - primarily the GMS, Long-Term Illness, Drugs Payment as well as the High Tech Arrangement – including fees and ingredient costs, is forecast at just over €1.7 billion in 2017. To ensure that patients receive the highest quality care, it is essential that the resources invested in medicines are used efficiently and effectively. This requires an integrated approach to secure best value for money for all treatments, to deliver greater efficiencies across the supply chain and also to promote the use of the most cost-effective treatments.
In 2013, the HSE established the Medicines Management Programme, MMP. It is headed by the National Medicines Information Centre, NMIC, and the National Centre for Pharmacoeconomics, NCPE, in collaboration with the HSE Primary Care Reimbursement Service, HSE-PCRS, and provides sustained national leadership relating to issues such as the quality of the medicines management process, access to medicines and the cost effective provision of medicines in Ireland.
The Medicines Management Programme has undertaken a number of initiatives aimed at enhancing evidence-based and cost-effective prescribing nationally and the review of Versatis is an example of this.
Versatis 5% medicated plaster is licensed for the symptomatic relief of neuropathic pain associated with previous herpes zoster (shingles) infection, known as post-herpetic neuralgia, PHN, in adults.
Following a review by the MMP of the evidence available to support the use of Versatis, the HSE has introduced a new system for the reimbursement of Versatis from 1 September 2017. This process will support the appropriate use of this medication while ensuring that those with an indication of post-herpetic neuralgia, PHN, continue to have access to this treatment. The HSE estimate that this new protocol will reduce expenditure on this product by approximately 90%.
The product has been reimbursed under the community drugs schemes in Ireland since 2010. Initially, the projected budget impact was low due to the specific licensed indication. However, total expenditure has increased significantly, from €9.4 million in 2012 to over €30 million in 2016, due primarily to off-license use i.e. prescribing Versatis as a general treatment for pain not associated with shingles. Currently, there are over 25,000 patients in receipt of this item. The MMP prescribing and cost guidance report highlighted that the clinical evidence to support the use of Versatis 5% medicated plaster for PHN is limited due to lack of comparative data and its value is uncertain for all other types of pain.
The NCPE estimated that, in Ireland, between 5-10% of the prescribing of this product is for the licensed indication of PHN.
All patients who currently receive antivirals for shingles, or patients who are prescribed antivirals for the treatment of shingles by their GP in the future, will automatically be approved for Versatis for a period of three months. No action is required by the GP in this instance and the patient’s pharmacy will be notified in real time of the patient’s approval status.
All patients who are currently initiated on Versatis have been identified and automatically registered on the HSE-PCRS system for a period of three months and will continue to receive the treatment from their pharmacy until 30 November 2017.
From 1 December 2017, non-shingles patients will no longer be dispensed Versatis under the community drugs schemes. The HSE has produced patient information leaflets and advised GPs on treatment alternatives.
In exceptional circumstances, the product may be dispensed for unlicensed indications. In such circumstances, the GP will be required to make an application for reimbursement for unlicensed indications for new and existing patients through the online system.
Where the application is under exceptional circumstances, the application will be reviewed by the MMP before a decision is made and communicated to the GP.
Full details of the review of Versatis are available on the HSE website at: http://hse.ie/eng/about/Who/clinical/natclinprog/medicinemanagementprogramme/yourmedicines/lidocaine-plaster/lidocaine-medicated-plaster.html.
As this is a matter for the HSE, I have no role in this decision in relation to individual treatments. However, I fully support the objectives of the HSE Medicines Management Programme.
305. Deputy Shane Cassells asked the Minister for Health his views on whether it is cost effective to place a person (details supplied) in a nursing home when a home care package would suffice in meeting their care needs; and if he will make a statement on the matter. [41305/17]
View answerAs the Deputy's question relates to an individual case, I have arranged for the question to be referred to the Health Service Executive for direct reply to the Deputy.
306. Deputy Mick Barry asked the Minister for Health the number of applications that have been received in the past year by the HSE from persons seeking a licence to use medicinal cannabis products here; the number of these applications that were granted; and the criteria that were used in accepting or rejecting applications [41306/17]
View answerThe Deputy will be aware that cannabis is listed in Schedule 1 of the Misuse of Drugs Regulations, which means that it is subject to the strictest level of control; however, under the Misuse of Drugs legislation it is open to me as Minister for Health to consider granting a licence to an Irish-registered medical practitioner for access to medical cannabis for a named patient.
The Chief Medical Officer has advised that the granting of such a licence must be premised on an appropriate application being submitted to my Department, which is endorsed by a consultant who is responsible for the management of the patient and who is prepared to monitor the effects of the treatment over time.
A licence application endorsed by the patient’s medical consultant and submitted under the Misuse of Drugs Acts must include:
- an outline of the treatment the patient has received to date and justification from the doctor as to why it is appropriate in their patient’s specific circumstances to prescribe a cannabis-based product;
- details of the cannabis-based product which it is proposed to prescribe and administer to the patient;
- the source of the cannabis-based product; and
- arrangements for the ongoing monitoring and care of the patient once the cannabis-based treatment has been initiated.
To date a valid licence application has been received by my Department in relation to one patient. A licence was subsequently granted to that applicant.
Where consultants require further information or clarification in relation to the licence application process, he or she should contact the Department of Health directly.
Ultimately it is the decision of the clinician, in consultation with their patient, to prescribe or not prescribe a particular treatment for a patient under their care and to make an application for a licence for cannabis for medical purposes. The Minister for Health has no role in the clinical decision-making process.
307. Deputy Niamh Smyth asked the Minister for Health if an appointment can be expedited for a person (details supplied); if so, the date for this appointment; and if he will make a statement on the matter. [41307/17]
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 National Waiting List Management Policy, A standardised approach to managing scheduled care treatment for in-patient, day case and planned procedures, January 2014, has been developed to ensure that all administrative, managerial and clinical staff follow an agreed national minimum standard for the management and administration of waiting lists for scheduled care. This policy, which has been adopted by the HSE, sets out the processes that hospitals are to implement to manage waiting lists.
The Directive on Patients' Rights in Cross Border Healthcare provides rules for the reimbursements to patients of the cost of receiving treatment abroad, where the patient would be entitled to such treatment in their home Member State, and supplements the rights that patients already have at EU level. Public patients may access the healthcare they require in either the public or private healthcare system of another Member State under the Cross-Border Directive, CBD. Access to healthcare abroad is based on patients following public patient pathways, i.e. they must demonstrate they have followed the equivalent public patient pathways that a patient would follow if accessing public healthcare in Ireland. It is important to note that reimbursement is confined to the costs of the care itself and that the rates of reimbursement cannot exceed the cost of provision of the care if it were provided in the Irish public health service. Referral for care under the CBD may be made by a GP, a hospital consultant and certain other HSE clinicians. The CBD excludes certain health services, e.g. services of public health, long-term care, organ transplantation, etc. All persons on public waiting lists, other than for such exempt health services, are eligible for the Scheme. Full details are available on the HSE website.
In relation to the particular query raised, as this is a service matter, I have asked the HSE to respond to the Deputy directly.
308. Deputy Jack Chambers asked the Minister for Health if the drug prembrolizumab will be licensed for use in the treatment of fine cell neuroendocrine rectal cancer; and if he will make a statement on the matter. [41316/17]
View answerThe HSE has statutory responsibility for decisions on pricing and reimbursement of medicines under the community drug schemes, in accordance with the provisions of the Health (Pricing and Supply of Medical Goods) Act 2013; therefore, the matter has been referred to the HSE for reply to the Deputy.
309. Deputy Jack Chambers asked the Minister for Health if the drug, Nivolumab, will be made available to persons in the public health system; and if he will make a statement on the matter. [41317/17]
View answer385. Deputy Thomas Byrne asked the Minister for Health when a drug will be available for a person (details supplied) who has been prescribed Nivolumab [41552/17]
View answer408. Deputy Pearse Doherty asked the Minister for Health when Nivolumab will be made available on the HSE primary care reimbursement service; and if he will make a statement on the matter. [41691/17]
View answerI propose to take Questions Nos. 309, 385 and 408 together.
The HSE has received separate applications for the reimbursement of Nivolumab (Opdivo) for eight separate indications, including for use as a combination therapy. These applications relate to funding of these treatments in the public health service.
Following an assessment by the HSE, and consultation with my Department regarding the funding implications, Nivolumab has been approved by the HSE for the treatment of:
- melanoma (monotherapy);
- renal cell carcinoma, and
- Hodgkins Lymphoma.
Following engagement between the HSE and the company, I understand that the HSE expect the reimbursement of Nivolumab for these indications in public hospitals to commence from 9 October 2017.
In addition, the HSE has decided not to support the use of Nivolumab in the treatment of locally advanced or metastatic non-small cell lung cancer.
Availability of these treatments in a private hospital is a matter between the individual patient, their health insurer and the hospital concerned.
Any decision by a private health insurer to link its policy on cover for a drug treatment in a private hospital to the HSE assessment process is a matter for the insurer and the private hospital concerned.
The remaining applications are currently being considered in line with the decision making criteria and are at different stages of the assessment process.
310. Deputy Bernard J. Durkan asked the Minister for Health when a medical card will issue in the case of a person (details supplied); if the application has been registered; if further documentation is outstanding; and if he will make a statement on the matter. [41318/17]
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.
311. Deputy Michael McGrath asked the Minister for Health further to Parliamentary Question No. 1202 of 11 September 2017, if the onus is on the manufacturer of the drug to initiate the process of having it added to the reimbursement list; and if not, if there is a way for affected persons to commence this process [41320/17]
View answerThe HSE has statutory responsibility for decisions on pricing and reimbursement of medicines under the community drug schemes, in accordance with the provisions of the Health (Pricing and Supply of Medical Goods) Act 2013; therefore, the matter has been referred to the HSE for reply to the Deputy.
312. Deputy Jack Chambers asked the Minister for Health the services in place to support persons that suffer strokes; if his attention has been drawn to the recommendations by an organisation (details supplied) for improving services for stroke sufferers; his plans to ensure there are properly resourced stroke units in hospitals which treat stroke patients; his further plans to ensure the standardisation of 24-7 clot busting thrombolysis treatment in each hospital treating acute stroke; if every person that suffers a stroke will have timely access to appropriate levels of in hospital rehabilitation; his plans to ensure the rollout of early supported discharge programmes nationally for persons that suffer a stroke to improve recovery outcomes and free up acute hospital beds; and if he will make a statement on the matter. [41323/17]
View answerThe National Clinical Programme for Stroke, NCPS, 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 to ensure sustained quality clinical operational management. Overall, the NCPS aims to improve quality, access and cost-effectiveness of stroke services in Ireland.
Some of the achievements of this programme in improving access to services to date include:
National 24/7 access to safe stroke thrombolysis
Emergency thrombolysis is provided to patients in all parts of the country, via improved hospital and ambulance protocols, health professional training and the appointment of new stroke physicians. The national stroke thrombolysis rate has increased from 1% in 2006 to a current rate of 12% (2016).
The NCPS has developed a number of initiatives including a telemedicine programme to allow delivery of expert thrombolysis therapy in smaller level three hospitals. It has been involved in the training of over 250 doctors nationally to deliver thrombolysis therapy and has participated in a training programme for Stroke in the Royal College of Physicians of Ireland.
Improved access to stroke unit care
Access to stroke unit care has been shown to improve stroke patient outcomes through reduced mortality rates, reduced dependency and shorter lengths of stay in hospital by patients. Since the commencement of the NCPS, nine new stroke units have been opened, bringing the total number of stroke units in acute hospitals to twenty-two. Two further stroke units are currently in development with a third at planning stages.
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Stroke Unit Available n22 |
Stroke Unit in development/planning n3 |
No Stroke Unit n2 |
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Mater Misericordiae University Hospital |
University Hospital Kerry |
Midland Regional Hospital Tullamore |
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St Vincent’s University Hospital |
Connolly Hospital |
Our Lady’s Hospital Navan |
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Midland Regional Hospital Mullingar |
Letterkenny University Hospital |
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Wexford General Hospital |
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St Luke’s Hospital Kilkenny |
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St James’s Hospital |
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Tallaght Hospital |
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Naas General Hospital |
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Midland Regional Hospital Portlaoise |
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Beaumont Hospital |
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Our Lady of Lourdes Hospital Drogheda |
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Cavan General Hospital |
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University Hospital Limerick |
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University Hospital Waterford |
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South Tipperary General Hospital Clonmel |
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Cork University Hospital |
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Mercy University Hospital |
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Bantry General Hospital |
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University Hospital Galway |
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Portiuncula Hospital |
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Mayo University Hospital |
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Sligo University Hospital |
This is a major improvement from the first national stroke care audit report in 2006 which reported one stroke unit in the country. However, stroke units are typically too small and the recent national Audit showed that only half of stroke patients admitted spent any time in a stroke unit.
Admission to a stroke unit is a National Key Performance Indicator. In 2016, 65.6% of stroke patients were admitted to a stroke unit.
Early Discharge of Stroke Patients
It has been recognised internationally that Early Supported Discharge of stroke patients from hospital, improves outcomes, reduces need for long term care and increases acute hospital capacity by freeing up beds. It is estimated the 10-25% of patients could benefit from an ESD service.
The programme has helped establish three small but effective ESD teams in Dublin and Galway. In 2016, 137 patients were discharged to ESD services representing 15.6% of total stroke discharges. It is estimated that there was an average reduction in length of stay of 10.4 days per ESD patient.
Funding for increasing capacity in the three operational sites has been secured for 2017, with further funding secured to support the establishment of two further teams in University Hospital Limerick and Cork University Hospital. Recruitment of these ESD staff is ongoing. University Hospital Limerick is due to commence its ESD Service on 11 September 2017.
Emergency Endovascular Therapy – Thrombectomy
Thrombectomy is an emergency endovascular procedure that permits patients with severe strokes caused by clots occluding the major vessels of the brain and neck to have these clots removed using specialist devices. HIQA has completed a Health Technology Assessment which finds that this intervention is value for money. Full report of the HIQA HTA can be found at: https://www.hiqa.ie/reports-and-publications/health-technology-assessments/hta-mechanical-thrombectomy-stroke.
Provision of emergency endovascular thrombectomy remains highly specialised in Beaumont Hospital and Cork University Hospital and this model has been endorsed by the HSE, Acute Hospital Division with a view to a third centre when numbers increase as expected.
To date, the number of patients undergoing this procedure has risen annually, on average almost 50% increase each year: 2015=122 cases, 2016=172 cases, 2017 – end of August=154 cases. These patients have been referred from 20 different hospitals around the country.
I have noted the contents of the Stroke Manifesto published by the Irish Heart Foundation and it will be one of the factors that will contribute to the ongoing policy development in this area.
313. Deputy Sean Sherlock asked the Minister for Health if respite care can be provided for a person (details supplied) in County Kildare. [41333/17]
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 Programme for Partnership Government states that the Government wishes to provide more accessible respite care to facilitate full support for people with a disability.
As the Deputy's question relates to an individual case, I have arranged for the question to be referred to the HSE for direct reply to the Deputy.
314. Deputy Jack Chambers asked the Minister for Health the financial supports or transport schemes available for a person (details supplied) who has severe spinal injuries and requires access to a car to maintain decent quality of life; and if he will make a statement on the matter. [41338/17]
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.
316. Deputy Timmy Dooley asked the Minister for Health when a person (details supplied) in County Clare who urgently needs an operation will receive an appointment for same; and if he will make a statement on the matter. [41340/17]
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 is a matter for the hospital to which the patient has been referred. Should a patient’s general practitioner consider the patient’s condition warrants and 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 the Deputy directly.
317. Deputy Robert Troy asked the Minister for Health if an appointment can be scheduled for a person (details supplied); and if he will make a statement on the matter. [41343/17]
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 National Waiting List Management Policy, A standardised approach to managing scheduled care treatment for in-patient, day case and planned procedures, January 2014, has been developed to ensure that all administrative, managerial and clinical staff follow an agreed national minimum standard for the management and administration of waiting lists for scheduled care. This policy, which has been adopted by the HSE, sets out the processes that hospitals are to implement to manage waiting lists.
In relation to the particular query raised, as this is a service matter, I have asked the HSE to respond to the Deputy directly.
319. Deputy Alan Kelly asked the Minister for Health when the post of director of nursing in child and adolescence in a mental health service in Cork city will be filled in view of the fact that it has been vacant for over a month and no process has commenced to fill it; the reason for the delay; and if he will make a statement on the matter. [41374/17]
View answerAs this is a service matter I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.
320. Deputy Fergus O'Dowd asked the Minister for Health if he will report on the decision on the reintroduction of day case charges for haemochromatosis patients attending the Louth County venesection clinic; his plans to reverse day charges for this life saving treatment; and if he will make a statement on the matter. [41388/17]
View answerThe Health Act 1970 (as amended) provides that all people ordinarily resident in the country are entitled, subject to certain charges, to public in-patient hospital services including consultant services and to public out-patient hospital services. Under the Health (In-Patients Charges) (Amendment) Regulations 2008, a person who has been referred to a hospital for an in-patient service, including that provided on a day-case basis, will have to pay the statutory daily charge, currently €80 per day, up to a maximum of €800 per year. On this basis, where venesection is classed as a day case procedure and is not carried out in an out patient setting, the public inpatient charge applies.
The Deputy may be aware of the ongoing review of the GMS and other publicly funded contracts involving GPs, and that the next phase of discussions to progress this work is underway. I expect that the issue of venesection services for patients with haemochromatosis will be considered in the context of the overall GP contract review process.
It should be noted that the Irish Blood Transfusion, IBTS, has been running a haemochromatosis clinic in the Stillorgan Blood Donation Clinic since 2007 and sees approximately 600 patients annually who are eligible to donate blood. In 2013 and 2014, the IBTS also commenced provision of a programme for hereditary haemochromatosis patients in their D'Olier Street and St. Finbar's Hospital (County Cork) clinics, respectively. These clinics provide venesection at no cost to the patient with a prescription from their treating clinician. The venesection is performed, regardless of whether the patient wanted to have their unit converted to a blood donation.
In response to the particular query raised, as this is a service matter, I have asked the HSE to respond to the Deputy directly.
