Written Answers Nos 554-570
554. Deputy Michael Healy-Rae asked the Minister for Health the reason for the requirement of a psychiatric diagnosis for a person (details supplied) when seeking hormone replacement therapy; and if he will make a statement on the matter. [12401/18]
View answerTransgender-specific guidelines have been developed by WPATH (World Professional Association for Transgender Health) and the Endocrine Society (who updated their guidelines in 2017). These guidelines were devised by experts in transgender healthcare, along with members of the International Transgender, Transsexual and LGBT community.
A proposed model of care for transgender children, adolescents and adults was submitted by the HSE Quality Improvement Division to the HSE Divisions of Primary Care, Mental Health and Acute Hospital programme. The model was developed in consultation with key treating clinicians, planners, policy makers, advocates and service users.
The guidelines recommend a comprehensive multidisciplinary psychosocial assessment prior to commencement of hormone therapy by endocrinology services. The assessment focuses on more than just assessment for the possible diagnosis of Gender Dysphoria. The guidelines highlight several criteria which must be met prior to referral for hormonal intervention. It is important that co-morbid conditions are identified and addressed, and that people access the supports that they need to manage co-morbid difficulties, which can impact on response to medical transition (including hormone treatment).
International best practice involves an assessment by a multi-disciplinary team and shared decision making in the best interests of the individual. Both WPATH and the Endocrine Society Guidelines 2017 specify the assessment must be carried out by a mental health professional (s) with experience in transgender healthcare and possess specific skills. Endocrinologists and General Practitioners (GPs) do not possess these skills, and require access to the multidisciplinary team as described. GPs would only see a small number of gender variant individuals during their lifetime in clinical practice, and would not be in a position to build up the requisite skill set outlined in WPATH and Endocrine Society Guidelines or have the time resource to conduct a comprehensive evaluation.
Informed consent is essential, whereby benefits and risks of hormone treatment and surgery are discussed with individuals seeking these interventions. Although regret rates are low, it can happen and can also lead to high levels of psychological distress. Healthcare providers work with people to try to prevent negative outcomes. The emerging evidence on good outcomes following medical and/or surgical transitioning is based on use of multi-disciplinary psychosocial assessment, fulfilment of criteria for hormones and on-going psychological support throughout the process. It is important that psychological support is available to individuals before, during and after transitioning.
Prescription of hormone blockers and cross-sex hormones for transgender people is relatively new. Significant side effects can occur with cross sex hormones including irreversible physical changes and infertility. There is a lack of long-term research on outcomes. For these reasons the decision to prescribe should only be made by specialists (i.e. Endocrinologists) in consultation with other professionals involved in the assessment process. Shared decision-making is in accordance with best practice internationally. Prescriptions can then be supported by local GPs with specialist guidance.
The model of care is providing the framework for the development of National Gender Clinics and MDTs for children and adults, funded by the Acute Hospitals and Mental Health Divisions of the HSE. Recruitment will commence to develop these national teams in 2018. It is envisaged that these National Teams will be in place in 2018, pending successful recruitment campaigns.
The HSE, across a number of programmes including mental health, acute hospitals, primary care and social inclusion, is committed to building services for this community in accordance with International Best Practice.
555. Deputy James Browne asked the Minister for Health the number of children between 12 and 18 years of age discharged from hospital with a principal diagnosis of anorexia or bulimia in each of the years 2005 to 2017, respectively; and if he will make a statement on the matter. [12402/18]
View answer556. Deputy James Browne asked the Minister for Health the number of children between zero and 12 years of age discharged from hospital with a principal diagnosis of anorexia or bulimia in each of the years 2005 to 2017, respectively; and if he will make a statement on the matter. [12403/18]
View answer557. Deputy James Browne asked the Minister for Health the number of persons over 18 years of age discharged from hospital with a principal diagnosis of anorexia or bulimia each of the years 2005 to 2017, respectively; and if he will make a statement on the matter. [12404/18]
View answer558. Deputy James Browne asked the Minister for Health the estimated number of persons here affected by an eating disorder; and if he will make a statement on the matter. [12405/18]
View answerI propose to take Questions Nos. 555 to 558, inclusive, together.
As these are service matters I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.
559. Deputy Michael Healy-Rae asked the Minister for Health the status of an appointment for a person (details supplied); and if he will make a statement on the matter. [12408/18]
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.
560. Deputy Michael Fitzmaurice asked the Minister for Health when a person (details supplied) will receive a decision on their medical card application; and if he will make a statement on the matter. [12409/18]
View answerAs this is a service matter I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.
562. Deputy Tom Neville asked the Minister for Health if a temporary home-care package will issue to a person (details supplied). [12415/18]
View answerAs this is a service matter I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.
563. Deputy Niamh Smyth asked the Minister for Health if a hospital appointment for a person (details supplied) will be expedited; and if he will make a statement on the matter. [12418/18]
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.
564. Deputy Michael Healy-Rae asked the Minister for Health the status of an assessment for further home-help hours for a person (details supplied); and if he will make a statement on the matter. [12419/18]
View answerAs this is a service matter I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.
565. Deputy James Browne asked the Minister for Health the number of girls and boys between 12 and 18 years of age who died under the care of the HSE from a principal diagnosis of anorexia or bulimia in each of the years 2005 to 2017, respectively; and if he will make a statement on the matter. [12426/18]
View answer566. Deputy James Browne asked the Minister for Health the number of children between zero and 12 years of age who died under the care of the HSE from a principal diagnosis of anorexia or bulimia for each of the years 2005 to 2017, respectively; and if he will make a statement on the matter. [12427/18]
View answer567. Deputy James Browne asked the Minister for Health the number of persons over 18 years of age who died under the care of the HSE from a principal diagnosis of anorexia or bulimia in each of the years 2005 to 2017, respectively; and if he will make a statement on the matter. [12428/18]
View answerI propose to take Questions Nos. 565 to 567, inclusive, together.
As these are service matters I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.
568. Deputy Sean Fleming asked the Minister for Health if the granting of medical cards to all persons who have been diagnosed with serious cancer while they are receiving treatment will be reconsidered; and if he will make a statement on the matter. [12430/18]
View answerThe HSE's Expert Group on Medical Need and Medical Card Eligibility examined the issue of awarding medical cards on the basis of illness and concluded that it was not feasible, desirable, nor ethically justifiable to list medical conditions in priority order for medical card eligibility. The Expert Group also concluded that a person’s means should remain the main qualifier for a medical card. This position remains unchanged.
Medical card provision is based on financial assessment. In accordance with the provisions of the Health Act 1970 (as amended), eligibility for a medical card is determined by the HSE. The Act obliges the HSE to assess whether a person is unable, without due hardship, to arrange general practitioner services for himself or herself and his or her family, having regard to his or her overall financial position and reasonable expenditure and every application must be assessed on that basis. Under the legislation, having a particular illness, in itself, does not establish eligibility for a medical card and therefore, the medical conditions of applicants for this scheme are not monitored on that basis. Where the applicant's income is within the income guidelines, a medical card or GP visit card will be awarded.
Every effort is made by the HSE, within the framework of the legislation, to support applicants in applying for a medical card and, in particular, to take full account of the difficult circumstances in the case of applicants who may be in excess of the income guidelines. It should be noted, in certain circumstances, the HSE may exercise discretion and grant a medical card, even though an applicant exceeds his or her income threshold, where he or she faces difficult financial circumstances, such as extra costs arising from an illness. Social and medical issues are considered when determining whether undue hardship exists for an individual accessing general practitioner or other medical services. The HSE affords applicants the opportunity to furnish supporting information documentation to fully take account of all the relevant circumstances that may benefit them in the assessment, including medical evidence of cost and necessary expenses.
569. Deputy Sean Fleming asked the Minister for Health when mepacrine will be reinstated for persons with medical cards who rely on it for treatment of skin disease in view of the fact that it can cost €200 per month; and if he will make a statement on the matter. [12431/18]
View answer570. Deputy Sean Fleming asked the Minister for Health when a medicine will be made available to a person (details supplied); and if he will make a statement on the matter. [12432/18]
View answerI propose to take Questions Nos. 569 and 570 together.
Under the Health (Pricing and Supply of Medical Goods) Act 2013, the HSE has statutory responsibility for the administration of the community drug schemes; therefore, the matter has been referred to the HSE for attention and direct reply to the Deputy.
