Thursday, 8 Feb 2018

Written Answers Nos 84-103

Hospital Waiting Lists Action Plans

Questions (84)

Marc MacSharry

Question:

84. Deputy Marc MacSharry asked the Minister for Health the targets in place for outpatient waiting times in Sligo university hospital in 2018; and if he will make a statement on the matter. [6426/18]

Written answers

Minister for Health

Reducing waiting times for patients is one of the Government's key priorities. In addition, all patients are prioritised according to clinical need.

The HSE Outpatient Waiting List Action Plan 2017 contained a specific target to reduce by 50% the number of patients who would be waiting 15 months or more for outpatient appointments by the end of October 2017. The Plan aimed to remove over 95,000 patients from the Outpatient Waiting List. This target was met with almost 100,000 patients coming off the Waiting List by the week ending 3 November.

Notwithstanding, the Outpatient Waiting List remains a significant challenge to be addressed in 2018. Outpatient activity has increased year-on-year, while the gap between referrals and appointment activity continues to widen, with 2017 data from the HSE indicating a gap of over 1,200 patients per week. Moreover, almost half a million (479,000) outpatients did not attend their outpatient appointment last year. This is an area that needs to be tackled.

Recent experience in relation to waiting list initiatives, including outsourcing, suggests that there are opportunities for further improvements and a number of steps including the commencement of a national waiting list validation project by the HSE, are being taken to ensure the lists are accurate. These efforts are to intensify in the coming months. My Department has also requested the HSE to develop an Outpatient Waiting List Action Plan for 2018, building on progress achieved last year.

In relation to the particular query raised, I have asked the HSE to respond to the Deputy directly.

Question No. 85 answered with Question No. 51.

Vaccine Damage Compensation Scheme

Questions (86)

Clare Daly

Question:

86. Deputy Clare Daly asked the Minister for Health the status of the progress of the programme for Government commitment to implement the recommendations of the vaccine damage steering group. [6206/18]

Written answers

Minister for Health

The Programme for a Partnership Government includes a commitment to “…put in place a scheme, on a no-fault basis, that will respond to the needs of people with disability arising from vaccination”. The final report of the Vaccine Damage Steering Group was published in 2009 and recommended establishing an ex-gratia payment scheme. The policy objectives in putting in place a scheme to meet the needs of people with disability arising from vaccination are to provide fair and just compensation for those who may have been injured by a vaccine, to reduce the costs to the State by providing an alternative to litigation and to maintaining public confidence in immunisation. This matter is under consideration with a view to developing a proposal regarding a vaccine damage scheme based on evidence, legal advices and consultation with other Government bodies.

Vaccination Programme

Questions (87)

Alan Kelly

Question:

87. Deputy Alan Kelly asked the Minister for Health when the HPV vaccine is to be extended to boys; when the report of the health technology assessment being carried out by HIQA in respect of the HPV vaccine for boys will be published; and if he will make a statement on the matter. [6096/18]

Written answers

Minister for Health

The immunisation programme in Ireland is based on the advice of the National Immunisation Advisory Committee (NIAC). NIAC is a committee of the Royal College of Physicians of Ireland comprising of experts in a number of specialties including infectious diseases, paediatrics and public health. The committee's recommendations are informed by public health advice and international best practice. All relevant and appropriate information is taken into account when deciding to make changes to the State's immunisation programmes.

NIAC has made a recommendation that the HPV vaccine should be given to boys. My Department asked the Health Information and Quality Authority (HIQA) to carry out a health technology assessment (HTA). Work has commenced on the HTA and is expected to be completed in 2018. Any decision to extend the current programme which offers HPV vaccination to all girls in their first year of second-level education to a programme that also offers vaccination to boys will be informed by the evidence contained in the HTA.

Hospital Waiting Lists Action Plans

Questions (88)

Aindrias Moynihan

Question:

88. Deputy Aindrias Moynihan asked the Minister for Health the steps he will take to reduce waiting lists for gynecological services at the Cork university maternity hospital; and if he will make a statement on the matter. [6296/18]

Written answers

Minister for Health

Reducing waiting times for patients is one of the Government's key priorities.

Data from the National Treatment Purchase Fund indicates, that as of 29 December 2017, there were 3,790 people waiting for Cork University Maternity Hospital (CUMH) gynaecology outpatient services and 425 people waiting for gynaecology inpatient/daycase services. Of this number, approximately 48% (202 people) were waiting less than 6 months for outpatient services and 46% (1,746 people) were waiting less than 6 months for inpatient/daycase services.

In 2017, I identified that particular focus should be placed on the gynaecology waiting list in the South/South West Hospital Group (SSWHG). In this context, an initiative which continues to be rolled out, was supported and funded through the NTPF. The SSWHG has developed a phased approach to improving waiting times for gynaecology services at CUMH. This includes the establishment of the SSWHG Women and Children's Services Directorate last year, which I expect will ensure better coordination and utilisation of maternity gynaecological resources across the group. I understand that additional funding is being made available for Cork University Hospital in 2018, including for gynaecology services.

Moreover, October's Budget announced a total allocation of €55m for the NTPF for 2018. This significant increase in funding more than doubles the 2017 total allocation of €20m. The NTPF and HSE are in the process of finalising Waiting List Action Plans and Initiatives for 2018. This will include ambitious targets for both the HSE and NTPF to reduce the overall number of patients waiting for treatment. I expect to publish the 2018 Inpatient Day Case Waiting List Action Plan by the end of February.

Question No. 89 answered with Question No. 25.

Health Services Expenditure

Questions (90)

Bernard Durkan

Question:

90. Deputy Bernard J. Durkan asked the Minister for Health the reason for an alleged shortfall in the health budget; if the information now emerging was brought to the attention of the budgetary and planning sections of the HSE or his Department; if particular issues have arisen which might require remedial budgetary action in the future; and if he will make a statement on the matter. [6363/18]

Written answers

Minister for Health

The National Service Plan 2018 sets out a budget of over €14.5 billion for the HSE which is the highest ever budget allocated. Since Budget 2015, the HSE has received significant additional funding of almost €2.5 billion, or an extra 20%, with an additional €600m provided for 2018 alone. This is a substantial additional level of funding for our health services and the HSE has indicated in the Service Plan that it will provide a level of service in 2018 that matches, and in some cases surpasses, that provided in 2017.

The amount allocated followed an extensive process between my Department, the HSE and DPER which considered both the estimated funding requirements submitted by the HSE, and the fiscal position. These type of engagements are a normal part of the Budgetary process and happen with agencies across Government and include public bodies putting forward spending proposals. Once the final allocation is determined by Government, it is necessary for all bodies, including the HSE, to operate within the allocation provided.

It is acknowledged that the issue of health funding is a major policy challenge, not only in Ireland but also internationally, and that the need for effective financial management is crucial. This is particularly the case with an increasing population, an ageing demographic, more acute health and social care requirements and rising demand and cost of both health technology and drugs. It is also important to state that the level of funding provided to the health services in this country compares favourably to health services internationally and health expenditure per capita is above the OECD average.

It should be noted that the Service Plan for 2018 also contains a specific section on improving value and services. Recognising the necessity to secure improved value, the HSE outlines a Value Improvement Programme in Section 7 of the Service Plan which will undertake a systematic review of its existing activities in order to drive value. This programme has three broad priority themes. The first is a programme focussed on cost reductions and savings at service level which targets €77m in savings. The second is a Corporate Value programme where the HSE will identify savings and cost reductions of €119m across their entire corporate operations. My Department will work with the HSE within a shared governance and oversight framework on the third strategic Value Improvement Programme. This will be a multi-year strategic initiative to identify and implement savings from productivity, improved models of care, policy and reform delivery, which is intended to secure savings of €150m.

General Medical Services Scheme Administration

Questions (91, 215)

Mick Wallace

Question:

91. Deputy Mick Wallace asked the Minister for Health the status of the general practitioner contractual review process, particularly in respect of the provision of routine phlebotomy services; and if he will make a statement on the matter. [6378/18]

Willie Penrose

Question:

215. Deputy Willie Penrose asked the Minister for Health the position regarding medical card holders undertaking blood tests for the purposes of monitoring their health on a recurring basis; if a charge can be levied by the general practitioner carrying out such blood tests; if so, if it can be reclaimed through the PCRS for the purpose of reimbursement of outlays associated with such a charge; if such charges are consistent with the commitment given by the former Minister of State at his Department in Dáil Éireann on 3 December 2015 which indicated that the contract was clear and explicit in this regard; and if he will make a statement on the matter. [6599/18]

Written answers

Minister for Health

I propose to take Questions Nos. 91 and 215 together.

There is no provision under the GMS GP contract for persons who hold a medical card or GP visit card to be charged for routine phlebotomy services provided by their GP which are required to either assist in the diagnosis of illness or the treatment of a condition. The HSE has advised GPs that where a blood test forms part of the investigation or necessary treatment of a patient’s symptoms or conditions, this should be free of charge for patients who hold a medical card or GP visit card. Notwithstanding this, I am aware that in recent times some GPs have begun to charge GMS patients for phlebotomy services in some circumstances.

This is a matter of concern for me as it has long been the position, under successive Governments, that no user charges should apply to GP services provided to GMS and GP visit card patients. If a patient who holds a medical card or GP visit card believes he or she has been incorrectly charged for routine phlebotomy services by his or her GP, then that patient may take the matter up with the HSE Local Health Office, who will deal with the matter in accordance with the HSE's Complaints Policy.

In relation to the talks on a new GP contract, it remains the position of my Department that routine phlebotomy services for the diagnosis of illness or the treatment of a condition are covered under the terms of the existing GP contract and should be free of charge for patients who hold a medical card or GP visit card.

Health Services Expenditure

Questions (92)

Thomas P. Broughan

Question:

92. Deputy Thomas P. Broughan asked the Minister for Health if he has submitted a request for additional supplementary funding for 2018 to address the waiting lists crisis in the health service; and if he will make a statement on the matter. [2129/18]

Written answers

Minister for Health

October's Budget announced a total 2018 allocation of €55m for the National Treatment Purchase Fund (NTPF) for 2018. This significant increase in funding more than doubles the 2017 total allocation of €20m. The HSE and the NTPF are in the process of finalising Waiting List Action Plans and Initiatives for 2018. This will include ambitious targets for both the HSE and the NTPF to reduce the overall patients waiting for treatment. I hope to publish the 2018 Inpatient Daycase Waiting List Action Plan by the end of February.

National Advisory Committee on Drugs Remit

Questions (93)

Maureen O'Sullivan

Question:

93. Deputy Maureen O'Sullivan asked the Minister for Health the status of the work of the National Advisory Committee on Drugs on examining dual diagnosis; and his views on the role of service users on that committee [6284/18]

Written answers

Minister of State at the Department of Health

The issues raised by the Deputy have been referred to the Health Service Executive for attention and direct reply to her.

Disabilities Assessments

Questions (94)

Paul Murphy

Question:

94. Deputy Paul Murphy asked the Minister for Health if it is policy not to adjust the start time on waiting lists for treatment by the school age team should an appeal find that the child's original needs assessment shows that the child is in need of treatment; and if he will make a statement on the matter. [6276/18]

Written answers

Minister of State at the Department of Health

The HSE is currently engaged in a reconfiguration of existing therapy resources to geographic based teams for children (0-18 years). The objective of the new model of assessment and intervention is to provide one clear referral pathway for all children (0-18s), irrespective of their disability, where they live or the school they attend. A total of 56 Children’s Network Disability Teams are currently in place with a further 82 teams expected by end of 2018.

The National Policy on Prioritisation of Referrals for Children’s Network Disability Teams (CNDTs) states that if a child’s service is transferred between CNDTs either due to a change of address or a move from an Early Intervention to a School Age team, the new team must take the date of the original referral to a CNDT as the date he/she was referred, not the date of transfer. This policy also provides clear criteria for prioritisation of referrals.

The Children’s Network Disability Services may comprise a 0 – 18 team or an Early Intervention, (0-5 years) and a School Age Team, (6 years to 18 years).

A key priority for the HSE is to improve waiting times for therapy services by implementing a revised model of care for children’s Speech and Language Therapy services and Psychology services and develop new models for Physiotherapy, Occupational Therapy and Lymphodema services. The Primary Care and Social Care Divisions are addressing waiting lists as a joint project, with a cross divisional team working on the detailed analysis of waiting times and resource deployment across the country. Social Care Children’s Disability Services and Primary Care Services are confident that through the implementation of the National Policy on Access to Services for Children and Young People with Disability and Developmental Delay, all children will have timely access to an appropriate service

The intention is to roll out an integrated care model that will allow children, whatever the nature of their disability, to be seen as locally to their home and school as possible; at primary care level when their needs can be met there and by a network disability team if their needs are more complex.

These measures will have a positive impact on the provision of clinical services for all children requiring access to health related supports and will lead to better outcomes for children and their families.

Mental Health Services Provision

Questions (95)

Tom Neville

Question:

95. Deputy Tom Neville asked the Minister for Health the details of the recent announcement to set up a national telephone and text help-line to access mental health services across the country; when he expects this help-line to be operational; and if he will make a statement on the matter. [6105/18]

Written answers

Minister of State at the Department of Health

One of the first things I set about doing when I was appointed Minister with responsibility for mental health was to establish a single point of contact for mental health services by telephone and text nationally. I was happy to receive the support of the HSE to establish this service. I do acknowledge that there are challenges in progressing this work. There are many very valuable service providers in the mental health sphere, however, I feel accessing these services can be simplified by having one access point nationally. The proposed help-line will be a single point of access to services that will seamlessly transfer a service user to a relevant service provider based on an initial assessment of need by a suitably qualified person and the service users proximity to a service provider.

HSE Mental Health Services have established a project to examine and progress a national telephone, text help-line and digital information/supports for those seeking support and services in respect of their mental health. The proposed service will focus on preventing mental health problems from developing and escalating, and on promoting good mental health through empowering people to self-manage their mental well-being. There is strong evidence that those seeking information/support are moving away from seeking help-line support and towards digital technologies. Accordingly the project will also have a focus on Digital solutions involving the use of information and communication technologies, as these are critically important in providing information, support and directing people to services where required.

These solutions can be used independently by an individual or suggested or signposted by a professional, and can be an integral part of mental health care and support. The benefits of using such solutions include; improved accessibility, consistency, quality and range of service offerings, real-time customisation of service, reduction in service provision costs, facilitation of service user empowerment, and potential to remove barriers to access including attitudinal, financial, temporal and those associated with stigma.

The Project Group to progress this work has been established, and a Project Manager appointed. Meetings have been held with key stakeholders including those currently offering telephone help-line supports in the field of mental health. A significant body of work will be associated with the integration of the existing specialist helplines into a single help-line number. The Project Lead for the telephony strand of the project is also responsible for the HSE Live service and a consultation process is in place to seek the views of existing providers on how they could be integrated into a single help-line number. It would be premature to posit a date of launch of a national help-line pending completion of these consultations/negotiations.

Question No. 96 answered with Question No. 50.

HSE Expenditure

Questions (97)

Dara Calleary

Question:

97. Deputy Dara Calleary asked the Minister for Health the way in which section 10(b) of the Health Service Executive (Financial Matters) Act 2014 is being honoured in the health budget for 2018; and if he will make a statement on the matter. [6430/18]

Written answers

Minister for Health

Section 10 (b) of the Health Service Executive (Financial Matters) Act 2014 states “(3) (a) If the amount of net expenditure incurred by the Executive in a financial year is greater than the amount determined by the Minister for that year, the Executive shall charge the amount of such excess to its income and expenditure account for the next financial year and (b) If the amount of net expenditure incurred by the Executive in a financial year is less than the amount determined by the Minister for that year, the Executive shall, subject to the approval of the Minister given with the consent of the Minister for Public Expenditure and Reform, credit the amount of such surplus to its income and expenditure account for the next financial year”.

It is important to note that the sum of a deficit or surplus as it arises, will not translate in full into a charge or credit on the Annual Financial Statements of the HSE, as any overrun or underspend in the voluntary sector is not subject to a first charge in the HSE accounts. In the context of reaching an agreement in relation to the National Service Plan, and cognisant of the fact that the real deficit will not be known until after the Annual Financial Statement's have been produced/audited, it is proposed that the first charge will not be applied at this stage and will be revisited when the figure is finalised.

Eating Disorders

Questions (98)

James Browne

Question:

98. Deputy James Browne asked the Minister for Health the mental health supports in place for persons with eating disorders. [6399/18]

Written answers

Minister of State at the Department of Health

If an individual has concerns in relation to eating disorders, he/she should be directed to their GP in the first instance for primary care screening assessment and examination. The GP may then make recommendations which may include referral to the secondary care mental health services for full eating disorder assessment.

Nationally, outpatient mental health services for adults presenting with eating disorders are provided by the General Adult Mental Health Teams across the country. Similarly, children and adolescents with eating disorders are treated by the Child & Adolescent Mental Health Service teams. Specialist training in the treatment of eating disorders has been provided to some clinicians from those teams as part of the National Clinical Programme in Eating Disorders.

Although most people with eating disorders do not require inpatient care, where an individual’s needs are more acute, inpatient admission may be required following the recommendation of the Consultant Psychiatrist or physician. When the risk is primarily physical and the person is in need of physical safety monitoring while re-feeding, admission will be to a HSE acute hospital under the care of a physician or paediatrician. Currently there are Specialist Eating Disorder services for adults (including in-patient bed provision) at St Vincent’s University Hospital in Dublin, and for children at Linn Dara Services also in Dublin.

The HSE is currently developing a Clinical Programme in Eating Disorders. The HSE recognises that although eating disorders are managed and treated by existing mental health services, these services may need support, particularly with high risk, severe and complex presentations. The Clinical Programme will help to develop greater capacity to manage people with eating disorders in the community, in order to reduce the likelihood of acute hospital treatment. As part of this Programme, a collaborative Model of Care was formally launched in January 2018. This includes a stepped model of care delivery; a specialist training programme for existing outpatient mental health services; a new dedicated National Eating Disorder Network; specialised inpatient Eating Disorder programmes within key existing psychiatric units nationally; and additional levels of care provided by the dedicated eating disorder network teams.

When this new collaborative Model of Care is implemented, there will be a national network of specialist eating disorder community team-based services and access to an enhanced level of special treatment beds. New clinical posts are being developed as part of this Clinical Programme, and in 2018, recruitment for these posts will be advanced.

HSE Funding

Questions (99)

John Brady

Question:

99. Deputy John Brady asked the Minister for Health if funding will be allocated to a service (details supplied) in County Wicklow in the HSE service plan; and if he will make a statement on the matter. [6110/18]

Written answers

Minister for Health

Section 39 of the Health Act 2004 makes provision for the HSE to provide assistance to bodies that provide services similar, or ancillary to, services that the HSE may provide.

Section 39 organisations provide a broad range of services and these are governed by Service Level Agreements with the HSE. Decisions on the provision of funding to these organisations is a matter for the HSE.

The HSE also operates a National Lottery funded scheme under which it provides grants to health agencies and other organisations. Details of the scheme are available on the HSE website at: http://www.hse.ie/eng/services/list/1/schemes/National-Lottery-Grants-2017/.

Mental Health Services Provision

Questions (100)

Peter Fitzpatrick

Question:

100. Deputy Peter Fitzpatrick asked the Minister for Health the measures being taken to improve CAMHS, for example, access, age appropriate placements, waiting lists and standardised operating procedures; and if he will make a statement on the matter. [6208/18]

Written answers

Minister of State at the Department of Health

As this is a service matter I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.

Hospital Services

Questions (101)

Bobby Aylward

Question:

101. Deputy Bobby Aylward asked the Minister for Health if additional resources will be allocated to the existing cardiac catheterisation laboratory at University Hospital Waterford to increase the laboratory's capacity to accommodate the estimated 450 additional procedures that will be referred there through additional diagnostic angiograms set to be provided by the mobile catheterisation lab; and if he will make a statement on the matter. [6093/18]

Written answers

Minister for Health

The Herity Report, published in July 2016, recommended investment to enhance cardiac services at University Hospital Waterford to address waiting times and to provide improved access for patients. Accordingly, an additional €500,000 was allocated to the hospital for 2017 with a further €500,000 being provided in 2018, to support extension of the existing cath lab operating hours as recommended. The HSE has advised that the process for the recruitment of staff in order to support the extension of hours is under way. The HSE has advised that, at the end of January 2018, of those waiting for cath lab procedures in University Hospital Waterford, 82 % of these have been waiting for 3 months or less and 97 % have been waiting for less than 6 months.

Seirbhís Otharchairr

Questions (102)

Catherine Connolly

Question:

102. D'fhiafraigh Deputy Catherine Connolly den Aire Sláinte an bhfuil sé ar an eolas faoi na deacrachtaí leanúnacha a bhaineann leis an tseirbhís otharchairr i dtuaisceart agus i ndeisceart Chonamara, Co. na Gaillimhe; an bhfuil sé ar an eolas go mbíonn othair, uaireanta, ag fanacht ar thaobh an bhóthair ar feadh níos mó ná uair an chloig; an bhfuil sé ar an eolas go bhfuil cúrsaí tromchúiseacha sláinte agus sábháilteachta i gceist; an bhfuil sé ar an eolas go bhfuil beatha na n-othar i mbaol [6370/18]

Written answers

Minister for Health

De bhárr gur ábhar seirbhíse atá i gceist, d'iarr mé ar Feidhmeannacht na Seirbhísí Sláinte (FSS) freagra a thabhairt duit go díreach.

Medicinal Products Availability

Questions (103)

John Brassil

Question:

103. Deputy John Brassil asked the Minister for Health the progress that has been made on the provision of Respreeza; and if he will make a statement on the matter. [6406/18]

Written answers

Minister for Health

The HSE has statutory responsibility for decisions on pricing and reimbursement of medicines under the community drugs schemes, in accordance with the Health (Pricing and Supply of Medical Goods) Act 2013.

The HSE carefully considered the pricing and reimbursement of human alpha1-proteinase inhibitor (Respreeza). The manufacturer, CSL Behring were notified in August 2017 that the HSE was unable to recommend reimbursement as they concluded that there was not enough evidence to suggest that patients would derive a clinically meaningful benefit from this treatment and that the current price was not a cost effective use of resources.

A number of patients were on a Respreeza access scheme, operated by the manufacturer CSL Behring for the treatment of Alpha-1 deficiency. This scheme was being run independently by CSL Behring and without reference to the HSE, when the Company decided that the scheme would end on 30 September 2017. This decision left approximately 20 patients without access to medication.

Subsequently the company modified its decision and agreed to continue to supply the medication free of charge for the patients on the access scheme for a further period of six months, or until the next clinical trial commences in 2018, but not to cover the cost of administering the medicine from the end of October 2017.

Due to the critical and exceptional circumstances, the HSE decided to facilitate a transitional arrangement under which it would fund the provision of the necessary nursing service to ensure that patients could continue to receive the medicine until a new clinical trial commences in 2018.

The Company anticipates that approximately half of the current access group of patients will be recruited into the next clinical trial in 2018.

The terms of this transitional arrangement, under which the HSE has agreed to fund the administration of the drug, includes a requirement that the lead clinician concerned ensures that appropriate alternative treatment regimes are put in place in good time for those patients not proceeding onto the next trial.

This transitional arrangement does not alter the reimbursement decision of the HSE in relation to Respreeza.

The company is welcome to submit a new reimbursement application which will be assessed in line with the 2013 Act.