Tuesday, 30 Jan 2018

Ministerial Expenditure

Questions (341)

Maurice Quinlivan

Question:

341. Deputy Maurice Quinlivan asked the Minister for Business, Enterprise and Innovation the reason the details of her expenses have not been uploaded to her Department’s website since July 2017; and her plans to ensure these are made available. [4470/18]

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Written answers

Minister for Business, Enterprise and Innovation

I was appointed as Minister for Business, Enterprise and Innovation on 30th November 2017. I have not claimed any expenses since my appointment. Details of any future expenses claimed will be made available on my Department's website on a quarterly basis.

Details of expenses claimed by my predecessor during her period in office (June 2017 - November 2017) are being collated and will be made available on my Department's website once finalised.

Job Creation Data

Questions (342)

Fergus O'Dowd

Question:

342. Deputy Fergus O'Dowd asked the Minister for Business, Enterprise and Innovation if she will provide the figures raised in correspondence (details supplied); and if she will make a statement on the matter. [4542/18]

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Written answers

Minister for Business, Enterprise and Innovation

IDA Ireland and Enterprise Ireland collate job figures on a county and region basis only. Details on employment numbers in individual cities or towns is unfortunately not available.

The following table provides a comprehensive breakdown of employment, in both IDA and EI supported companies, across each county in 2017.

2017	IDA Total Jobs	IDA New Jobs Created (Gross Gains)	IDA Additional Jobs Created (Net Change)	IDA Client Companies	EI Total Jobs	EI New Jobs Created (Gross Gains)	EI Additional Jobs Created (Net Change)
Carlow	875	75	73	7	3,034	250	158
Cavan	1,155	31	-48	7	5,451	434	269
Clare	6,775	446	40	68	3,709	339	136
Cork	35,248	2,388	1,417	158	25,975	2,214	1,372
Donegal	3,389	375	350	12	3,552	375	132
Dublin	88,318	10,956	6,393	735	72,461	6,921	3,044
Galway	17,696	1,281	764	75	8,103	1,044	707
Kerry	2,186	105	89	14	4,866	415	319
Kildare	9,282	275	-947	28	9,134	673	421
Kilkenny	782	138	20	6	4,276	340	102
Laois	119	4	4	2	1,473	168	109
Leitrim	889	89	86	5	559	100	61
Limerick	10,677	1,028	850	56	8,269	879	664
Longford	474	77	-198	5	2,970	174	146
Louth	3,702	295	109	24	6,121	656	310
Mayo	4,462	272	228	16	4,118	322	178
Meath	1,491	71	-35	17	7,302	651	309
Monaghan	150	14	13	5	5,366	494	223
Offaly	940	74	26	10	4,281	433	203
Roscommon	1,128	153	143	10	1,776	127	86
Sligo	2,184	63	-106	23	1,733	212	169
Tipperary	3,665	341	297	11	5,907	574	427
Waterford	6,850	682	597	37	6,359	482	256
Westmeath	2,794	235	221	17	3,741	342	249
Wexford	2,948	284	268	18	4,670	342	117
Wicklow	2,264	99	30	18	4,132	371	142
	210,443	19,851	10,684	1,384	209,338	19,332	10,309

Departmental Staff Retirements

Questions (343)

Peter Burke

Question:

343. Deputy Peter Burke asked the Minister for Business, Enterprise and Innovation the number of persons at assistant principal level under the aegis of her Department due to retire in the next six months due to age in counties Galway, Mayo, Roscommon and Clare; and if she will make a statement on the matter. [4969/18]

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Written answers

Minister for Business, Enterprise and Innovation

Within the counties listed, there are no Assistant Principal officers due to retire from my Department, its Offices or any of the Agencies under its aegis in the next six months.

Transport Support Scheme

Questions (344)

Aengus Ó Snodaigh

Question:

344. Deputy Aengus Ó Snodaigh asked the Minister for Health when the alterative scheme to the mobility allowance and the transport support scheme will be introduced. [3942/18]

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Written answers

Minister of State at the Department of Health

I was pleased to have the opportunity to discuss the proposed Health (Transport Support) Bill with the Joint Committee on Public Petitions on Wednesday 11th October 2017. The Deputy will be familiar with the background to the closure of both the Mobility Allowance and Motorised Transport Grant schemes in February 2013. Since the closure of the Mobility Allowance, the Government has directed that the Health Service Executive should continue to pay an equivalent monthly payment of up to €208.50 per month to the 4,133 people in receipt of the Mobility Allowance, on an interim basis, pending the establishment of a new Transport Support Scheme.

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. The Programme for a Partnership Government acknowledges the ongoing drafting of primary legislation for a new Transport Support Scheme to assist those with a disability to meet their mobility costs. The Health (Transport Support) Bill is on the list of priority legislation for publication in the Spring/Summer session 2018. 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 draft General Scheme and Heads of Bill were circulated to other government Departments and have been the subject of consultation between the Department of Health and the Department of Public Expenditure and Reform. It is hoped to circulate a revised Memo for Government and General Scheme shortly, seeking Government approval to the drafting of the Bill for the new Transport Support Payment.

It is important to note that the Disabled Drivers and Disabled Passengers scheme operated by the Revenue Commissioners, remains in place. This scheme provides VRT and VAT relief, an exemption from road tax and a fuel grant to drivers and passengers with a disability, who qualify under the relevant criteria set out in governing regulations made by the Minister for Finance.

Specifically adapted vehicles driven by disabled persons are also exempt from payment of tolls on national toll roads and toll bridges. Transport Infrastructure Ireland has responsibility for this particular Scheme.

Speech and Language Therapy

Questions (345)

Seán Sherlock

Question:

345. Deputy Sean Sherlock asked the Minister for Health the options open to a person (details supplied) for speech and language therapy. [4127/18]

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Written answers

Minister of State at the Department of Health

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 an individual case, I have arranged for the question to be referred to the Health Service Executive (HSE) for direct reply to the Deputy.

Hospital Procedures

Questions (346, 347, 348, 441, 442)

Clare Daly

Question:

346. Deputy Clare Daly asked the Minister for Health his plans to institute a ban on the use of transvaginal mesh in view of the permanent and debilitating side effects of same and in further view of full or partial bans in the UK, New Zealand and Australia. [4879/18]

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Clare Daly

Question:

347. Deputy Clare Daly asked the Minister for Health his plans to launch a public awareness campaign in regard to the severe and lifelong side effects of transvaginal mesh in some cases and in view of the fact that many women suffering such side effects have been disbelieved or ignored over many years (details supplied). [4881/18]

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Clare Daly

Question:

348. Deputy Clare Daly asked the Minister for Health if his attention has been drawn to the findings of the PROSPECT study which concluded that transvaginal mesh is of no benefit in pelvic organ prolapse repair; and if he will make a statement on the matter. [4882/18]

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Catherine Connolly

Question:

441. Deputy Catherine Connolly asked the Minister for Health further to Parliamentary Questions Nos. 165 to 167, inclusive, of 23 November 2017, if consideration has been given to the suspension of the use of transvaginal mesh while the report of the Chief Medial Officer is awaiting completion; and if he will make a statement on the matter. [4404/18]

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Catherine Connolly

Question:

442. Deputy Catherine Connolly asked the Minister for Health further to Parliamentary Questions Nos. 165 to 167, inclusive, of 23 November, 2017, when the report of the chief medical officer in relation to transvaginal mesh implants will be available; and if he will make a statement on the matter. [4405/18]

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Written answers

Minister for Health

I propose to take Questions Nos. 346 to 348, inclusive, 441 and 442 together.

As Minister for Health, I want to ensure that both the current use of mesh implants in urogynaecological procedures in Ireland, and the on-going clinical management of women who have had these procedures in the past, are in line with international best practice and emerging evidence.

At my request, the Chief Medical Officer is preparing a report on the many clinical and technical issues involved.

This work involves engagement with national and international bodies, the professional colleges and others. This work is underway and will take a number of months to complete.

The advice from the Health Products Regulatory Authority (HPRA) continues to be that it is not aware of scientific evidence which concludes these devices are unsafe when used in line with their intended use. The Health Products Regulatory Authority (HPRA) continues to liaise closely with European Competent Authorities, the European Commission and with International regulatory agencies in relation to the international evidence relating to these devices. To date, no regulatory action has been taken by Competent Authorities in any European country in respect of the use of transvaginal mesh.

The safety of surgical meshes used in urogynecological surgery has been reviewed in Europe by the Scientific Committee on Emerging and Newly Identified Health Risks (SCENIHR). SCENIHR was requested to provide a scientific opinion on the safety of surgical meshes used in contemporary pelvic surgery. The Opinion of the SCENIHR was approved in December 2015 and is available, together with a summary of the outcome, on the website of the European Commission

http://ec.europa.eu/health/scientific_committees/consultations/public_consultations/scenihr_consultation_27_en.

SCENIHR states that ‘synthetic sling SUI surgery is an accepted procedure with proven efficacy and safety in the majority of patients with moderate to severe SUI, when used by an experienced and appropriately trained surgeon. Therefore, the SCENIHR supports continuing synthetic sling use for SUI, but emphasises the importance of appropriately trained surgeons and detailed counselling of patients about the associated risk/benefits’. SCENIHR also highlights that “the implantation of any mesh for the treatment of POP via the vaginal route should only be considered in complex cases, in particular, after failed primary repair surgery”.

The Department strongly advises that any woman who experiences or suspects that she has experienced a complication associated with TVMI surgery should discuss this with her GP or with the hospital from which she received the implant. The Department also advises that women considering surgery involving TVMIs should thoroughly discuss with their doctors the indications, alternatives (surgical and non-surgical), benefits and risks involved in their personal circumstances.

Hospital Procedures

Questions (349)

Timmy Dooley

Question:

349. Deputy Timmy Dooley asked the Minister for Health when a person (details supplied) will have additional surgery carried out; and if he will make a statement on the matter. [3932/18]

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Written answers

Minister for Health

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.

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 you directly.

EU Directives

Questions (350, 355, 366, 367, 403)

Catherine Murphy

Question:

350. Deputy Catherine Murphy asked the Minister for Health his plans to include chiropractors in new guidelines for X-ray referral; his further plans to extend and-or re-open the consultation phase regarding the new guidelines; and if he will make a statement on the matter. [3943/18]

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Michael Healy-Rae

Question:

355. Deputy Michael Healy-Rae asked the Minister for Health his views on a matter (details supplied); and if he will make a statement on the matter. [3967/18]

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Thomas P. Broughan

Question:

366. Deputy Thomas P. Broughan asked the Minister for Health if he will report on the European Union (Basic Safety Standards for Protection Against Dangers Arising from Medical Exposure to Ionising Radiation) Regulations 2018, which he is due to sign on 6 February 2018; the meaning of these regulations for medical practitioners here; if chiropractors' use of X-rays will be included in these regulations; when he expects the regulations to be operational; and if he will make a statement on the matter. [4015/18]

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Thomas P. Broughan

Question:

367. Deputy Thomas P. Broughan asked the Minister for Health when he will meet with an organisation (details supplied) regarding the European Union (Basic Safety Standards for Protection Against Dangers Arising from Medical Exposure to Ionising Radiation) Regulations 2018; and if he will make a statement on the matter. [4016/18]

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Joan Collins

Question:

403. Deputy Joan Collins asked the Minister for Health if he will address a matter (details supplied). [4189/18]

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Written answers

Minister for Health

I propose to take Questions Nos. 350, 355, 366, 367 and 403 together.

These questions relate to the transposition of the medical provisions of the Basic Safety Standards Directive (BSSD) by my Department and whether chiropractors will be designated as referrers and practitioners in the transposing regulations.

Ionising radiation has many beneficial applications however as the use of ionising radiation increases, so does the potential for health hazards if not properly used or contained. The BSSD is an essential piece of legislation which protects the public, patients, workers and others from all forms of ionising radiation.

My Department conducted a general consultation on the BSSD in June 2017 and sought views on the provisions of the Directive where Member States had discretion. The Chiropractic Association of Ireland (CAI) was included in my Department's notification of the consultation process and arrangements were made to contact all licence holders of ionising radiation equipment advising them of the consultation. Information on the consultation process was also posted on my Department’s website. No response was received from the CAI or any individual identifying as a chiropractor.

The transposing statutory instrument for the BSSD will revoke and replace existing regulations from 2002. The existing regulations do not designate chiropractors as referrers or practitioners. Chiropractors who refer individuals for medical exposures, carry out medical exposures or other related functions are not in compliance with the existing regulations.

The current regulations lack inspection or enforcement provisions, however, in the new regulations HIQA will have the inspection and enforcement powers to enforce compliance and contravention of the new regulations will be an offence.

The statutory instrument transposing the BSSD will designate those who may refer for radiological tests, those who may carry them out and other functions and in this regard I propose to designate nurses, doctors, dentists and radiographers as appropriate.

The proposed designation of relevant professionals is based on patient safety and public health considerations reflected in the advice of the Chief Medical Officer.

The Department of Communications, Climate Action and Environment has overall responsibility for the transposition of the BSSD. My Department will finalise the medical provisions of the BSSD in the coming weeks.

Drugs Payment Scheme Coverage

Questions (351)

Peter Burke

Question:

351. Deputy Peter Burke asked the Minister for Health the reason a person (details supplied) has been refused authorisation for medication; and if he will make a statement on the matter. [3951/18]

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Written answers

Minister for Health

Medicines play a vital role in improving the health of Irish patients. Securing access to existing and new and innovative medicines is a key objective of the health service. However, the challenge is to do this in an affordable and sustainable manner. The medicines bill for the community drugs schemes – primarily the GMS, Long Term Illness and Drugs Payment schemes and the High Tech Arrangement – was approximately €1.8 billion in 2017.

To ensure patients receive the highest quality care, resources invested in medicines must be used efficiently and effectively. This requires an integrated approach to secure best value for money for all treatments, greater efficiencies in the supply chain and the use of the most cost-effective treatments.

Lidocaine 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. It has been reimbursed in the community drugs schemes since 2010. The projected budget impact on introduction was low due to the specific licensed indication but total expenditure has increased significantly, from €9.4 million in 2012 to over €30 million in 2016, mainly from off-license use for pain not associated with shingles.

An HSE Medicines Management Programme (MMP) review of this product highlighted that the clinical evidence for its use in PHN is limited due to lack of comparative data, and its value is uncertain for all other types of pain. The National Centre for Pharmacoeconomics estimated that, in Ireland, only 5-10% of prescribing of this product has been for the licensed indication of PHN.

Following the MMP review, the HSE introduced a new reimbursement system for the product from 1 September 2017. This process supports its appropriate use, ensuring that PHN patients continue to receive this treatment. The HSE estimates that this protocol will reduce annual expenditure on this product by approximately 90%.

Under the protocol, all patients who were receiving antivirals for shingles were automatically approved for the lidocaine medicated plaster for three months. No action was required by GPs and the patient’s pharmacy was notified of his or her approval status.

These patients were identified and automatically registered on the HSE-PCRS system for three months and continued to receive the treatment from their pharmacy until 30 November 2017. However, since 1 December 2017, non-shingles patients no longer receive this item under the community drugs schemes. The HSE has produced information leaflets for patients and advised GPs on treatment alternatives.

In exceptional circumstances, the product may be approved for supply through the community schemes for unlicensed indications. GPs apply for reimbursement for unlicensed indications through the online system. The MMP reviews applications before a decision is made and communicated to the GP.

Full details of the review are available on the HSE website at

http://hse.ie/eng/about/Who/clinical/natclinprog/medicinemanagementprogramme/yourmedicines/lidocaine-plaster/lidocaine-medicated-plaster.html.

This decision is a matter for the HSE. However, I fully support the objectives of the HSE Medicines Management Programme.

Drugs Payment Scheme Coverage

Questions (352)

Michael Harty

Question:

352. Deputy Michael Harty asked the Minister for Health if the criteria of availability for Versatis patches can be reviewed in view of the number of persons who require same (details supplied); and if he will make a statement on the matter. [3952/18]