Written Answers Nos. 645-664
645. Deputy Jack Chambers asked the Minister for Health the waiting lists for disability teams for those of schoolgoing age by age group and local health area; and if he will make a statement on the matter. [35699/18]
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 service matters, I have arranged for the question to be referred to the Health Service Executive (HSE) for direct reply to the Deputy.
646. Deputy Fiona O'Loughlin asked the Minister for Health the status of an appointment for a person (details supplied). [35702/18]
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, since 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.
647. Deputy Fiona O'Loughlin asked the Minister for Health the status of a placement for a person (details supplied). [35711/18]
View answerAs this is a service matter, it has been referred to the Health Service Executive for attention and direct reply to the Deputy.
648. Deputy Fiona O'Loughlin asked the Minister for Health the status of an appointment for a person (details supplied). [35712/18]
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, since 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.
649. Deputy Fiona O'Loughlin asked the Minister for Health the status of the case of a person (details supplied). [35713/18]
View answerAs this is a service matter I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.
650. Deputy David Cullinane asked the Minister for Health the reason for the delay in the opening of the Dungarvan primary care centre; the cost overruns that have been incurred as a result of the delay; and if he will make a statement on the matter. [35715/18]
View answerAs the Health Service Executive is responsible for the delivery of healthcare infrastructure projects, I have asked the HSE to respond directly you in relation to this matter.
651. Deputy Jack Chambers asked the Minister for Health further to Parliamentary Question No. 1445 of 24 July 2018, the definition of "timely fashion" with regard to the submission of a reimbursement application; the timeline for the application to be processed; if the process can be fast-tracked in view of the fact it is a second time application; if his attention has been drawn to the urgent nature of the application; and if he will make a statement on the matter. [35721/18]
View answer655. Deputy Danny Healy-Rae asked the Minister for Health if an application submitted by a company (details supplied) will be prioritised to ensure the availability of the drug Translarna; and if he will make a statement on the matter. [35730/18]
View answer661. Deputy James Browne asked the Minister for Health if a timeline will be provided for the consideration of an application for the drug Translarna by a company (details supplied); and if he will make a statement on the matter. [35740/18]
View answer667. Deputy Catherine Murphy asked the Minister for Health further to Parliamentary Question No. 482 of 12 July 2018, the length of time it takes the HSE to conduct a timely review with regard to the relevant statutory framework; and if he will make a statement on the matter. [35749/18]
View answer930. Deputy Brendan Smith asked the Minister for Health his plans to make Translarna available through the HSE for young persons needing this particular medication in view of its availability in the UK and in 22 European countries; and if he will make a statement on the matter. [36762/18]
View answerI propose to take Questions Nos. 651, 655, 661, 667 and 930 together.
The Health Service Executive has statutory responsibility for decisions on pricing and reimbursement of medicines under the community drug schemes, in accordance with the Health (Pricing and Supply of Medical Goods) Act 2013.
Accordingly, I have asked the HSE to reply to you directly.
652. Deputy Mattie McGrath asked the Minister for Health if he will request the National Advisory Committee on Bioethics to initiate a review on the topic of conscientious objection within healthcare settings; and if he will make a statement on the matter. [35727/18]
View answerThe National Advisory Committee on Bioethics was established to advise the Minister for Health on the ethical and social implications of scientific developments in human medicine and healthcare.
As the Deputy will be aware no decision has been made regarding the next topic on the work programme for the National Advisory Committee on Bioethics.
653. Deputy Mattie McGrath asked the Minister for Health the remuneration made available to members of the National Advisory Committee on Bioethics in each of the past five years; and if he will make a statement on the matter. [35728/18]
View answerThe National Advisory Committee on Bioethics was established to advise the Minister for Health on the ethical and social implications of scientific developments in human medicine and healthcare.
The National Advisory Committee on Bioethics’ membership is multi-disciplinary in nature. The Committee members give of their time and expertise voluntarily, though they may claim for reasonable expenses incurred in relation to attending Committee meetings, for example, travel costs.
There were no expenses claimed by Committee members for the years 2018, 2017, 2016 or 2014 for attendance at meetings of the National Advisory Committee on Bioethics. In the case of 2015, the total remuneration of Committee members’ expenses was €701.27.
654. Deputy Mattie McGrath asked the Minister for Health the amount spent on legal and-or mediation fees relating to court or legal challenges involving the CervicalCheck cancer screening programme in each of the past four years; and if he will make a statement on the matter. [35729/18]
View answerThe information requested by the Deputy is not readily available, but has been requested from the State Claims Agency. Accordingly, I will forward the details to the Deputy as soon as it is provided.
656. Deputy Michael Healy-Rae asked the Minister for Health the status of an operation for a person (details supplied); and if he will make a statement on the matter. [35733/18]
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, since 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.
657. Deputy David Cullinane asked the Minister for Health the reason for the suspension of screening services for breast and ovarian cancer at St. James's Hospital, Dublin 8; and if he will make a statement on the matter. [35734/18]
View answer871. Deputy Caoimhghín Ó Caoláin asked the Minister for Health the status of the screening service at St. James's Hospital, Dublin, for women at a high risk of developing breast cancer; if this service is suspended due to funding issues for new diagnostic machines; the measures in place to resolve the issue; and if he will make a statement on the matter. [36484/18]
View answerI propose to take Questions Nos. 657 and 871 together.
St James’s Hospital, as a designated cancer centre, runs a Rapid Access Clinic for Symptomatic Breast Disease.
In parallel with the Rapid Access Breast Clinic, a Familial Breast Cancer Risk Assessment Service at St. James’s Hospital has evolved to provide a clinical service to women who are considered to be at a higher than average risk of developing breast cancer in their lifetime. Due to increased referral rates to the Symptomatic Breast Disease Clinic, as well as to the ‘family risk’ clinic, the hospital is currently prioritising the symptomatic patients to ensure that a quality, timely and sustainable service is available to them. This has resulted in the suspension of the family risk service, other than for urgent cases.
One of the hospital’s two mammography machines which was at end of life has recently been replaced. A third machine is on order and will be available in the coming months. Capacity for mammography has been a major part of the challenge in meeting demand for breast services in St James's.
The intention is to restore the Familial Breast Cancer Risk Assessment Service in St James's as soon as possible and, indeed, to build a programme for hereditary cancers in designated cancer centres over the coming years.
658. Deputy Pearse Doherty asked the Minister for Health the staffing levels at the department of psychiatry, Letterkenny University Hospital; the details of the positions and vacancies at the hospital; and if he will make a statement on the matter. [35737/18]
View answerIn relation to the particular query raised, as this is a service matter, I have asked the HSE to respond to the Deputy directly.
659. Deputy Pearse Doherty asked the Minister for Health the number of patient referrals made to the department of psychiatry at Letterkenny University Hospital in each of the years 2015 to 2017, inclusive, and to date in 2018; and if he will make a statement on the matter. [35738/18]
View answerIn relation to the particular query raised, as this is a service matter, I have asked the HSE to respond to the Deputy directly.
660. 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. [35739/18]
View answerAs this is a service matter it has been referred to the HSE for direct reply to the Deputy.
662. Deputy Seán Haughey asked the Minister for Health if a ban on the use of mesh for prolapse and urinary incontinence will be considered in view of the severe difficulties it has caused many women; and if he will make a statement on the matter. [35741/18]
View answer708. Deputy Seán Haughey asked the Minister for Health his plans to ensure that medical facilities for the removal of transvaginal mesh are put in place here, including the appointment of surgeons; and if he will make a statement on the matter. [35855/18]
View answer859. Deputy Sean Fleming asked the Minister for Health his views in regard to the mesh implant that many women have used for prolapsed bladder; if he is satisfied with its continued use here; and if he will make a statement on the matter. [36428/18]
View answer861. Deputy Seán Haughey asked the Minister for Health if the necessary arrangements will be made to allow a person (details supplied) to carry out full removal operations in a hospital here for a six-week period in January and February 2019; if his attention has been drawn to the fact that the treatment abroad scheme and the EU Cross-Border Healthcare Directive are not available to women requiring such full removal surgery; and if he will make a statement on the matter. [36430/18]
View answer908. Deputy John Curran asked the Minister for Health if a full audit by hospital of all transvaginal mesh implants will be arranged; if so, if the audit will include details of all known defective devices; and if he will make a statement on the matter. [36625/18]
View answerI propose to take Questions Nos. 662, 708, 859, 861 and 908 together.
As Minister for Health I am committed to putting in place the measures necessary to ensure that both the current use of Transvaginal mesh implants (TVMIs) in surgical procedures in Ireland, and the ongoing 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 (CMO) is preparing a report which will make recommendations in relation to the clinical and technical issues involved. I am informed that following policy actions in relation to mesh by health authorities in the NHS and in Northern Ireland in July 2018, as set out below, further engagements with the HSE, the Health Products Regulatory Agency, the professional bodies and colleagues in other jurisdictions were needed for the purpose of finalising the report. I am informed that the CMO’s Report is anticipated to be completed in the coming weeks.
Pending finalisation of the report, a number of significant system actions in relation to mesh implants have already been advanced.
The CMO wrote to the Acting Director General of the Health Service Executive on 20 July 2018 to request that the Executive put immediate measures in place to:
Pause the use of all procedures involving uro-gynaecological/transvaginal mesh implants for the management of Stress Urinary Incontinence (SUI) or Pelvic Organ Prolapse (POP) in HSE funded hospitals, in cases where it is clinically appropriate and safe to do so.
Ensure that in situations where expert clinical judgment is that there is an urgency to carry out the procedure and no suitable alternative exists, surgery should proceed only if a delay would risk harm to the patient and should be based on multidisciplinary team decision and fully informed consent.
This pause is to remain in place pending confirmation of implementation by the Health Service Executive, working in conjunction with the Institute of Obstetricians and Gynaecologists (IOG) and the Royal College of Surgeons in Ireland (RCSI), of three urgent recommendations relating to:
(i) Surgical Training,
(ii) Informed Consent and
(iii) the Development of an agreed Dataset of Mesh Procedures.
The Department also wrote to the Institute of Obstetricians and Gynaecologists, the Royal College of Surgeons in Ireland and the Continence Foundation of Ireland on requesting that they assist the HSE in progressing these recommendations on an urgent basis.
The HSE has published information for patients on its website concerning the pause.
It is acknowledged that there may be concerns that restricting the availability of mesh procedures, particularly SUI mesh procedures, which are widely accepted to be less invasive and more effective than non-mesh alternatives will delay access to treatment procedures for distressing symptoms. Advice received in relation to this is that uro-gynaecological mesh procedures are largely elective procedures and it is not anticipated that a postponement of weeks / months will materially affect health outcomes for the majority of women affected. Given the limited number of surgeons and units carrying out these procedures in HSE funded hospitals, it is anticipated that the Executive will be in a position to indicate to the Department that these recommendations have been implemented within a number of months.
The decision to institute a pause in vaginal mesh procedures in HSE funded hospitals followed a review by Department officials, together with representatives of the HSE and the Health Products Regulatory Authority (HPRA), of the NHS England decision of Tuesday 10 July to institute a similar ‘pause’ in their use. This decision in the NHS followed a recommendation by the Independent Medicines and Medical Devices Safety (IMMDS) Review established in February 2018 by the Secretary of State for Health and Social Care, the Rt. Hon Jeremy Hunt MP. On Wednesday July 11, a pause was instigated by health authorities in Northern Ireland.
It has been clarified by the NHS that there is no concurrent change in the evidence base concerning these devices. The recommendations of the IMMDS to NHS England arose because of a lack of certainty or confidence that critical clinical governance measures to assure the safety of mesh procedures are demonstrably in place. The Department considers that similar concerns in relation to the visibility and consistency of such measures apply equally in the public health system here.
There is understandable public and patient anxiety about the ongoing safety of mesh devices in light of the considerable publicity that this issue has received and this has been heightened by recent developments in the NHS. It is important that this be addressed as comprehensively as possible. A pause on the use of mesh procedures, pending confirmation by the Executive that the recommendations as set out above have been implemented, is considered proportionate and necessary to provide public assurance that these procedures are being carried out in accordance with internationally accepted good practice.
The advice of the HPRA to the Department is that it supports a temporary restriction on all procedures involving uro-gynaecological/transvaginal mesh implants, pending the introduction of the further clinical mechanisms proposed relating to the delivery of care for patients. The regulatory status of uro-gynaecological mesh implants at a European level remains unchanged in that they are CE marked medical devices. As such, the benefit-risk profile for the devices is considered positive. Ensuring that the use of transvaginal mesh is appropriate and as safe as possible requires, not only that the device is safe and performs as intended, but also that the healthcare system has appropriate measures for patient selection, treatment and follow-up in place.
In relation to the provision of appropriate aftercare for women suffering from mesh complications, including appropriate diagnostic facilities, this has already been identified as one of two priority recommendations for immediate advancement by the Executive in the course of preparation of the CMO’s report. The CMO wrote to the Acting Director General of the HSE, and to the Institute of Obstetricians and Gynaecologists (IOG), the Royal College of Surgeons in Ireland (RCSI), and the Continence Foundation of Ireland (CFI) on May 28 2018, requesting that the Executive commence work on (i) the development of appropriate patient information resources and consent materials and (ii) clarification and development of treatment pathways and appropriate referral services for women suffering from mesh-related complications, in conjunction with the IOG, the RCSI and the CFI.
The HSE has confirmed that work has commenced by the National Women and Infants Health Programme (NWIHP) in the HSE to progress all of the recommendations above. A Learning Notice concerning mesh devices in uro-gynaecological procedures was circulated by the NWIHP on 26 June 2018 to all maternity hospitals and acute hospitals with gynaecological services to highlight the importance of appropriate patient selection, adequate information and consent and also to inform the service providers that a Response Group has been convened to propose remedies for and address the provision of aftercare for complications. This learning notice has been posted on the NWIHP website.
The experiences of women concerned will be an essential element to informing the assessment of need and identifying the aftercare services required. I am informed that a Synthetic Mesh Devices Advisory Group has been convened by the NWIHP which includes three patient representatives, as well as representatives of the HPRA, the IOG, the RCSI, the CFI and all Hospital Groups to advise on and action all of the recommendations.
This work is ongoing and will include identifying the appropriate specialist clinical expertise and facilities required at hospital group level and nationally to provide comprehensive aftercare services. It will also include an examination of the role of and requirement for specialist diagnostic services such as translabial scanning. The outcome of this work will clarify if there is a need to look at sourcing services from abroad to address any shortfalls identified at national level, either through utilisation of the treatment abroad scheme or by commissioning services from abroad.
The HSE advice is that all patients who have experienced complications due to mesh devices are advised to contact their consultant’s clinic in the first instance. Each hospital group has nominated an individual to coordinate a response to this group of patients. If patients are having trouble accessing information they can contact the National Women & Infants Health Programme at smi.nwihp@hse.ie for help.
For all patients wishing to access services abroad there are two potential schemes which may be available to patients, namely the Treatment Abroad Scheme and the Cross-Border Directive. Details of the qualifying criteria for both schemes may be found on the HSE website - details below.
It is important to note that both schemes are only applicable for patients accessing care via the public patient pathway. Referrals of private patients or from private hospital consultants are not eligible for consideration under TAS for example, nor can an outpatient appointment in a private capacity be accepted for the purposes of access healthcare under the Cross-Border Directive, however, for the purposes of the Cross-Border Directive, a GP may refer a patient for an out-patient appointment abroad.
It is open to private patients to apply to their private health insurance provider in relation to accessing funding towards the cost of treatment abroad. However, if this request for assistance is declined a patient can seek to access treatment through either of the above schemes if they follow the public patient pathway.
Details of both the TAS and CBD can be accessed on the HSE’s website or by contacting the office on 056 778 4551.
663. Deputy Louise O'Reilly asked the Minister for Health the status of the proposed new diabetic unit for Sligo University Hospital; and when capital funding will be sanctioned for building work to commence. [35742/18]
View answerAs the Health Service Executive is responsible for the delivery of healthcare infrastructure projects, I have asked the HSE to respond directly to you in relation to this matter.
664. Deputy Barry Cowen asked the Minister for Health when a person (details supplied) will receive a hospital appointment. [35744/18]
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, since 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.
