Hospitals Funding

Questions (240)

Brendan Smith

Question:

240. Deputy Brendan Smith asked the Minister for Health if additional resources will be provided in order to ensure maximum utilisation of capacity at a hospital (details supplied); and if he will make a statement on the matter. [4911/18]

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Written answers (Question to Health)

Budget 2018 allocated a total of €55 million for the national treatment purchase fund, NTPF, which more than doubles the 2017 allocation of €20 million.

This funding will enable the provision of treatment for patients on the inpatient/daycase waiting list across a range of specialties and procedures and will focus on long-waiting patients and overall waiting list numbers. The NTPF will work with both public and private hospitals in order to provide access for patients to treatment.

The HSE and NTPF are currently preparing a waiting list action plan for 2018, with a specific focus on reducing the number of patients waiting the longest for inpatient and daycase procedures. I expect to publish this plan at the end of February.

The HSE has advised me that work is currently on-going in the Ireland East Hospital Group to finalise the 2018 budget allocation for Cappagh Orthopaedic Hospital. It is expected that Cappagh Hospital will be funded for a similar level of activity in 2018, as 2017.

The NTPF has advised me that at the end of last year they funded the treatment of 83 patients in Cappagh Hospital. In addition, to date in January this year a further 17 hip/knee replacements funded by the NTPF have been completed in Cappagh.  The HSE advise that Cappagh Hospital will also be undertaking an additional 200 orthopaedic procedures (joint replacements) this year on behalf of the NTPF. These procedures will be targeted at those who are waiting over 15 months for surgery.

The NTPF are continuing to engage with Cappagh Orthopaedic Hospital to identify potential further waiting list initiatives, which could be undertaken in the context of the additional funding allocated to the NTPF this year and the waiting list action plans for 2018.

Health Service Capacity Review

Question No. 242 answered with Question No. 223.

Questions (241)

Billy Kelleher

Question:

241. Deputy Billy Kelleher asked the Minister for Health the estimated full-year cost of increasing health service capacity as detailed on page nine of the executive summary of the health service capacity review; and the costs for both scenarios provided, in tabular form. [4912/18]

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Written answers (Question to Health)

The terms of reference and the scope of the capacity review did not include the costing of additional capacity. The analysis has established two extremes that define the indicative range and scale of potential capacity needs up to 2031 and the level of reforms involved. The key findings and recommendations of the report recognise this and outline further work required, including:

-assessing the optimum reform strategy that takes account of workforce, the whole life cost of services, eligibility arrangements and their impact on implementing reforms, the feasibility of delivering infrastructure, and impact on operational services in the timeframe. It would also need to take account of the wider implications arising from major reconfigurations of services across hospitals;

- consideration of the Capacity Review in the context of the forthcoming National Development Plan; and

- an important next step noted in the report is to consider how additional capacity should be planned and delivered at a regional level based on population need.

As the Deputy will appreciate, costing is an important and complex process in its own right. For example, it is important to state that there is no one cost for a hospital bed. The cost is dependent on the nature of the bed, such as inpatient, daycase, critical care, the specialty and where the bed will be delivered, for example, an existing hospital, an extension, or a new development. Therefore, the steps I mentioned will be examined in the context of both the forthcoming National Development Plan and the Sláintecare Implementation Plan.

As a final point, I would just reiterate what I have stated previously, that adding additional capacity cannot be the only answer. In tandem with this, we need fundamental reform of our health system - with significant development of the primary and community care system. Sláintecare provides the blueprint for this.

Question No. 242 answered with Question No. 223.

Ambulance Service Data

Questions (243)

Billy Kelleher

Question:

243. Deputy Billy Kelleher asked the Minister for Health the number of ambulance attendances at each emergency department nationwide in December 2017, in tabular form; the number of such ambulances that waited longer than 20 minutes to hand over patients, retrieve their trolleys and return to responding to calls; and the number that waited longer than 40, 60, 90, 120 and more than 180 minutes for same, respectively. [4914/18]

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Written answers (Question to Health)

As this is a service issue, I have asked the HSE to reply to you directly.

Commencement of Legislation

Questions (244)

Aindrias Moynihan

Question:

244. Deputy Aindrias Moynihan asked the Minister for Health the timeframe for the commencement of Parts 2 and 3 of the Children and Family Relationships Act 2015. [4936/18]

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Written answers (Question to Health)

Officials in my Department are undertaking the work necessary to facilitate the commencement of parts 2 and 3 of the Children and Family Relationships Act 2015. We are working to resolve a small number of technical issues in order to ensure that the processes associated with Parts 2 & 3 of the Act can be commenced. I hope to be in a position to lay the regulations before the Houses of the Oireachtas as early as possible in 2018.

Citizenship Status

Questions (245)

Aindrias Moynihan

Question:

245. Deputy Aindrias Moynihan asked the Minister for Health the citizenship status of a person (details supplied) under the Children and Family Relationships Act 2015. [4937/18]

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Written answers (Question to Health)

The provisions of Parts 2 and 3 of the Children and Family Relationships Act 2015, which fall within the remit of my Department, relate to children born within the State. As the scenario which the Deputy describes relates explicitly to a child born outside of the State, the provisions of the Irish Nationality and Citizenship Act 2004 will apply.

Health Services Provision

Questions (246)

Thomas P. Broughan

Question:

246. Deputy Thomas P. Broughan asked the Minister for Health his plans to increase access to the weight management programme and bariatric surgery during 2018; the number of persons who accessed the programme in each of the years 2015 to 2017; and if he will make a statement on the matter. [4938/18]

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Written answers (Question to Health)

Reducing waiting times for the longest waiting patients is one of this Government's key priorities. Waiting times are often unacceptably long and I am conscious of the burden that this places on patients and their families.

Budget 2018 allocated a total of €55 million for the National Treatment Purchase Fund, NTPF, and more than doubles the 2017 allocation of €20 million. The HSE and the NTPF are currently preparing 2018 waiting list action plans for 2018, with a specific focus on reducing the number of patients waiting the longest for inpatient and daycase procedures.

In addition, Budget 2018 also announced funding under the winter measures in 2017, which facilitated the roll out of further waiting list initiatives. In this context, the HSE has targeted key areas and specialties where there are patients in need of complex high-cost care. This includes additional funding to support the purchase of equipment and consumables for bariatric surgery in St Vincent's University Hospital which will provide the basis for provision of additional activity in 2018.

I have asked the HSE to respond to you directly in respect of the particular issues raised.

Medical Aids and Appliances Provision

Questions (247)

Brendan Smith

Question:

247. Deputy Brendan Smith asked the Minister for Health if a medical appliance (details supplied) will be restored as an item covered by the medical card as was the position previously; and if he will make a statement on the matter. [4955/18]

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Written answers (Question to 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://www.hse.ie/eng/about/Who/cspd/ncps/medicines-management/lidocaine-plaster/

This decision is a matter for the HSE. However, I fully support the objectives of the HSE medicines management programme.

Land Reclassification

Questions (248)

Peadar Tóibín

Question:

248. Deputy Peadar Tóibín asked the Minister for Agriculture, Food and the Marine if it is policy to support the existence of cow parks (details supplied); and his plans to protect the last remaining cow parks in the future. [4668/18]

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Written answers (Question to Agriculture)

Under the provisions of the Irish Land Commission (Dissolution) Act, 1992, the disposal of the remaining lands, including trust lands (including cow parks), is an essential element in concluding the orderly wind up of the former Irish Land Commission.