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Tuesday, 12 Feb 2019

Written Answers Nos. 350-370

Public Health Policy

Questions (350)

Denise Mitchell

Question:

350. Deputy Denise Mitchell asked the Minister for Health the timeline for the consideration of the collated outcomes from Connect, Collaborate, Create; Co-Designing Healthier Communities, A Healthy Ireland Stakeholder Forum on the Built Environment by the relevant Departments, the national physical activity plan implementation group and the obesity policy implementation oversight group for the purposes of advancing work in the area of health and environmental planning; if there is a proposed timeline for the development of these materials; if not, the reason therefor; and if he will make a statement on the matter. [6299/19]

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Written answers

Connect, Collaborate, Create; Co-Designing Healthier Communities, A Healthy Ireland Stakeholder Forum on the Built Environment, was held on November 21st 2018, in the National Indoor Arena. The event was organised by the cross-Governmental Implementation Groups overseeing the National Physical Activity Plan and the Obesity Policy and Action Plan.

The Forum brought together those who have a responsibility for planning and developing public spaces with those who have expertise regarding the impacts of the built and natural environments on all aspects of health and well-being, including sport and physical activity, obesity and mental health, with the objective of examining how our physical environment can impact on our collective health.

The format for this event consisted of a number of talks and presentations from many key stakeholders, followed by a workshop and discussion. Written feedback was gathered from all of the groups participating in the workshop and has now been collated. This material is currently being analysed and core points are being identified.

A meeting will be held in the coming weeks between the Department of Health, the Department of Transport, Tourism and Sport, and the Department of Housing, Planning and Local Government to consider the points raised and to identify the next steps in the process, which will include consideration by the two policy implementation oversights groups referred to.

Hospital Services

Questions (351)

Charlie McConalogue

Question:

351. Deputy Charlie McConalogue asked the Minister for Health the status of the reopening of a ward at a hospital (details supplied); if the first tranche of beds have now been opened; when the remaining beds will be open; and if he will make a statement on the matter. [6318/19]

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Written answers

As Minister for Health, I recognise that hospitals are increasingly operating at or above capacity, with year-round demand pressures that are further challenged over the winter months. It is against this background that the Health Service Capacity Review 2018 recommended an increase in acute hospitals beds of over 2,600 by 2031 to support the projected increase in demand for services in the years ahead.

Increasing capacity is therefore a priority for the Government. Over the past 18 months, an additional 240 beds have been opened.

A Capacity Programme for 2019 has been agreed, which provides for the following increases to capacity, as set out in the National Service Plan 2019:

78 additional beds are planned for 2019, including the 40-bed modular build in South Tipperary General Hospital, the 30-bed ward in Our Lady of Lourdes Hospital Drogheda, 4 HDU beds in Cork University Hospital and 4 HDU beds in the Mater Hospital;

75 acute beds and 70 community beds to come on stream in 2019, as part of the Winter Plan 2018/19, including 5 additional beds in Letterkenny University Hospital due for opening in quarter 1 2019;

and preparation of 202 beds, of which 16 are critical care, by quarter 4 2019 with a view to bringing this extra capacity into operation in the first quarter of 2020, including additional beds in Letterkenny University Hospital.

Nursing Homes Support Scheme

Questions (352)

Aindrias Moynihan

Question:

352. Deputy Aindrias Moynihan asked the Minister for Health when legislation will be brought forward to implement the proposed changes in the fair deal scheme outlined in February 2018; the full extent of the changes; and if he will make a statement on the matter. [6326/19]

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Written answers

The proposed policy change to the Nursing Homes Support Scheme (NHSS), to cap contributions from farm assets at 3 years where a family successor commits to working the productive asset, has been approved by Government. My Department is working on the development of draft Heads of Bill while considering a number of complex ancillary policy and operational matters which may need to be addressed in the proposed legislation.

It is intended that this proposed policy change, the 3 year cap, will be extended to eligible existing participants in long term residential care so that they are not disadvantaged, but that there would be no retrospective recoupment of contributions for those who have paid contributions over and above the 3 year period.

A draft General Scheme of a Bill is currently with legal advisers for advice and legal quality control review. Subject to legal advice, I expect to bring the heads of bill to Government soon. The changes to the Scheme will come into effect in 2019 subject to the legislative process.

General Medical Services Scheme

Questions (353)

Richard Boyd Barrett

Question:

353. Deputy Richard Boyd Barrett asked the Minister for Health the reason a person with a full medical card is charged for blood tests in a general practitioner surgery; and if he will make a statement on the matter. [6328/19]

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Written answers

Under the terms of the current GMS contract, GPs are required to provide eligible patients with  ''all proper and necessary treatment of a kind usually undertaken by a general practitioner and not requiring special skill or experience of a degree or kind which general practitioners cannot reasonably be expected to possess." 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 some GPs are charging 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 should report the matter to their HSE Local Health Office.

Medicinal Products Availability

Questions (354)

Eugene Murphy

Question:

354. Deputy Eugene Murphy asked the Minister for Health the arrangements and-or instructions issued to the HSE with regard to the supply of vital medicines in respect of Brexit; and if he will make a statement on the matter. [6332/19]

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Written answers

As part of the overall Government response to Brexit, my Department is working on a comprehensive and coordinated set of actions to ensure, as far as is possible, continuity of supply of medicines in the event of a "no-deal" Brexit.

Significant work has been undertaken by my Department, the HSE, and the Health Products Regulatory Authority (HPRA), together with medicines manufacturers and suppliers, to ensure that risks to the continuity of supply are mitigated to the greatest possible extent.

The Department of Health, HSE and HPRA do not anticipate an immediate impact on medicine supplies should there be a no-deal Brexit on 29 March. There are already additional stocks of medicines routinely built into the Irish medicine supply chain, and these additional stocks, together with planning by Revenue to allow the fast-tracking of essential drugs into Ireland, where necessary, will help deal with any delays that may arise.

It is important to note that there is no need for hospitals, pharmacists or patients to order extra quantities of medicines, or for doctors to issue additional prescriptions. To do so could disrupt existing stock levels and hamper the supply of medicines for other patients.

In 2018, the HPRA developed and launched a multi-stakeholder Medicine Shortages Framework to anticipate and manage medicine shortages when they occur. The health system is therefore well placed to anticipate and respond to any additional shortages, should they arise because of Brexit.

As an additional safeguard, my Department requested that consideration be given to those categories of medicines which are considered most essential to public health. As a result, HSE and HPRA technical experts are undertaking a process to verify the contingency planning in place for the continuity of supply of medicines essential to public health, in order to determine those medicines that have the potential to be vulnerable to supply disruption and, where necessary, identify clinically appropriate alternatives. Work on this process is ongoing and will continue in the months before and after Brexit.

Both the HPRA and HSE have requested that medicines manufacturers and suppliers highlight any issues regarding the availability of specific products associated with Brexit and, to date, no major issues have been identified through this process.

Cancer Services Provision

Questions (355)

John Brassil

Question:

355. Deputy John Brassil asked the Minister for Health the steps being taken to ensure that cancer patients have access to innovative new cancer treatments at the same time as those in other European countries; and if he will make a statement on the matter. [6335/19]

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Written answers

A standard process is in place for the HSE reimbursement of new drugs, and new indications for existing drugs. This assessment process aims to ensure that decisions on the funding of drugs are clinically appropriate, fair, consistent and sustainable. The process is underpinned by the Health (Pricing and Supply of Medical Goods) Act 2013.

Many Irish cancer patients also access new cancer treatments through clinical trials. The National Cancer Strategy 2017-2026 envisages increased recruitment of  patients to clinical trials over the period of the Strategy.

National Cancer Strategy

Questions (356, 357)

John Brassil

Question:

356. Deputy John Brassil asked the Minister for Health his plans regarding strengthening the role of the national cancer control programme in delivering the National Cancer Strategy 2017-2026 as per recommendation No. 44; and if he will make a statement on the matter. [6334/19]

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John Brassil

Question:

357. Deputy John Brassil asked the Minister for Health the status of the implementation of the National Cancer Strategy 2017-2026; the funding allocated in 2019 towards the implementation of same; and if he will make a statement on the matter. [6336/19]

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Written answers

I propose to take Questions Nos. 356 and 357 together.

The National Cancer Strategy 2017-2026 Implementation Report 2018 was published on 4th February. This sets out the progress achieved on the implementation of the 52 recommendations of the Strategy, and the degree to which the key performance indicators are being met, to the end of 2018. It is available on the Department of Health website at: health.gov.ie/wp-content/uploads/2019/02/NCS-Implementation-Report-2018.pdf.

The National Cancer Control Programme is continuing their central role in the implementation of the Strategy. They control some direct funding which is utilised in a targeted way to maximise improvements in the quality and accessibility of cancer services.

The National Cancer Control Programme received increased funding of €8.9 m for cancer services under the HSE's National Service Plan 2019.

National Children's Hospital Expenditure

Questions (358)

Peadar Tóibín

Question:

358. Deputy Peadar Tóibín asked the Minister for Health the preparation undertaken to ensure that the chain of command for administering the procurement and building of the national children's hospital project was prepared, skilled and stress tested in order to prevent spiralling cost overruns. [6340/19]

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Written answers

Established under the National Paediatric Hospital Development (Establishment) Order 2007, the National Paediatric Hospital Development Board (NPHDB) has statutory responsibility for the planning, designing, building and equipping of the new children’s hospital and outpatient and urgent care centres.

Notwithstanding the NPHDB's clear statutory responsibility for the construction of the hospital, because of the range of other elements to the overall programme to relocate services to the new hospital once commissioned, and the need for appropriate oversight of all inter-related service and capital elements of the programme, in 2017 revised governance structures were approved by Government and put in place to oversee and monitor progress on the children's hospital project and integration programme. The Children's Hospital Project and Programme (CHP&P) Steering Group, chaired by the Deputy Director General of the Health Service Executive was established to direct the overall programme of work. This Steering Group reports to the CHP&P Board, chaired by the Secretary General of my Department, which oversees and monitors progress on the project and programme.

Government approved the commissioning of an independent review of the escalation in cost in determining the adjusted contract sum in relation to the new children’s hospital. This independent review has been commissioned by the HSE and is being undertaken by PwC. The review will be completed by the end of March, subject to availability of relevant documentation and personnel and will inform any governance or other changes required. The review will establish the sequence of events in relation to the cost increases experienced by the project; establish what was known, when and by whom, and the reporting of relevant information from the project team to the relevant oversight and governance bodies including NPHDB Board and also its Committees, the HSE and the Department of Health. The review will comment not just on the major residual risks and the robustness and completeness of the current forecasts, but also identify and where possible quantify those risks contractually excluded from the Guaranteed Maximum Price. The terms of reference also require the review to develop any further recommendations which may identify any areas of potential cost savings or reductions, which are consistent with the applicable contractual undertakings and the delivery of the project, in light of its current status, address major residual risks, control and oversight issues and bring greater oversight of performance and value for money.

National Children's Hospital Expenditure

Questions (359)

Peadar Tóibín

Question:

359. Deputy Peadar Tóibín asked the Minister for Health if unsuccessful bidders for development of the national children's hospital will be included in the investigation into the spiralling of costs; if employees who undertake the procurement for large infrastructure projects such as this have a contractual obligation to ensure that costs of projects do not spiral out of control; and if not, the way in which he will hold those responsible for the cost overruns to account. [6341/19]

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Written answers

The terms of reference of the independent review of the escalation in cost in determining the adjusted contract sum in relation to the new children's hospital do not address issues relating to unsuccessful bidders.

 The review will establish the sequence of events in relation to the cost increases experienced by the project; establish what was known, when and by whom, and the reporting of relevant information from the project team to the relevant oversight and governance bodies including NPHDB Board and also its Committees, the HSE and the Department of Health. The review will comment not just on the major residual risks and the robustness/completeness of the current forecasts, but also identify and where possible quantify those risks contractually excluded from the Guaranteed Maximum Price/adjusted contract sum.

The terms of reference also require the review to develop any further recommendations which may identify any areas of potential cost savings or reductions, which are consistent with the applicable contractual undertakings and the delivery of the project, in light of its current status, address major residual risks, control and oversight issues and bring greater oversight of performance and value for money. Under the terms of reference, the review will deal with the accountability of the relevant key parties, functions and roles. This may inform next steps by decision makers, including Government.

The review will be completed by the end of March, subject to availability of relevant documentation and personnel and will inform any governance or other changes required.

Home Help Service Provision

Questions (360)

Niamh Smyth

Question:

360. Deputy Niamh Smyth asked the Minister for Health further to Parliamentary Question No. 475 of 16 October 2018 if home help hours will be sanctioned for a person (details supplied); and if he will make a statement on the matter. [6343/19]

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Written answers

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

Disability Services Provision

Questions (361)

Niamh Smyth

Question:

361. Deputy Niamh Smyth asked the Minister for Health the status of respite care, occupational therapy, home support and speech and language therapy appointments in the case of a person (details supplied); and if he will make a statement on the matter. [6354/19]

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Written answers

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

Hospital Waiting Lists

Questions (362)

Timmy Dooley

Question:

362. Deputy Timmy Dooley asked the Minister for Health when a child (details supplied) will have an assessment for surgery; and if he will make a statement on the matter. [6355/19]

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Written answers

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, 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.

Hospital Waiting Lists

Questions (363)

Peadar Tóibín

Question:

363. Deputy Peadar Tóibín asked the Minister for Health the number of persons on waiting lists for occupational therapy by county; the number waiting more than three, six and nine months and one year, respectively, by county; and the longest length of time waited for the service. [6356/19]

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Written answers

As this question relates to service matters, I have arranged for the question to be referred to the Health Service Executive (HSE) for direct reply.

HSE Correspondence

Questions (364)

Jackie Cahill

Question:

364. Deputy Jackie Cahill asked the Minister for Health further to Parliamentary Question No. 421 of 22 January 2019 if he will request the HSE to issue a response as promised (details supplied); and if he will make a statement on the matter. [6357/19]

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Written answers

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

Cannabis for Medicinal Use

Questions (365)

Fiona O'Loughlin

Question:

365. Deputy Fiona O'Loughlin asked the Minister for Health if a person (details supplied) can be given a licence for medicinal cannabis; and if he will make a statement on the matter. [6361/19]

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Written answers

It is important to note that the medical decision to prescribe or not prescribe any treatment, including cannabis treatment, for an individual patient is strictly a decision for the treating clinician, in consultation with their patient. As Minister for Health I have no role in this clinical decision-making process.

Medical practitioners and patients may consult the Department of Health website for detailed information on medical cannabis, including clinical guidance on the use of medical cannabis and details on who is permitted under legislation to apply for a licence, and how those persons may apply for a Ministerial licence for medical cannabis. This information can be found at the following link: https://health.gov.ie/blog/publications/cannabis-for-medical-use/.

Members of the Oireachtas were advised of this repository of information via a circular from the Controlled Drugs Unit of the Department of Health in October 2018.

If your constituent or their clinicians require any further details or clarification, having consulted the website, they should contact the Department of Health directly.

National Children's Hospital Expenditure

Questions (366)

Peadar Tóibín

Question:

366. Deputy Peadar Tóibín asked the Minister for Health the contractual obligations included in the procurement process to prevent spiralling costs in the development of the national children's hospital. [6370/19]

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Written answers

Established under the National Paediatric Hospital Development (Establishment) Order 2007, the National Paediatric Hospital Development Board (NPHDB) has statutory responsibility for the planning, designing, building and equipping of the new children's hospital and outpatient and urgent care centres.

The size, complexity and specialist nature of the new children's hospital project informed the decision by the NPHDB to adopt a two-stage procurement process comprised of:

Procurement Stage 1: A full tender and contract for Phase A (below ground including basement works) on the basis of a detailed design with the tendering of Phase B (the main above ground works) on a Preliminary 1st stage design with an approximate and remeasurable bill of quantities reflecting the Preliminary 1st stage design. Contract Awarded to main and specialists contractor 3rd August 2017.

Procurement Stage 2: While the basement Phase A works were under construction, the 2nd stage detailed design for the above ground Phase B works was completed with a full bill of quantities priced at the 1st stage Preliminary design tendered rates. The contract becomes in effect a lump sum contract. Phase B works instructed 8 January 2019.

The procurement strategy was developed and finalised from 2014 to 2016. The Government Contracts Committee, the cross-government consultative committee for construction procurement matters, accepted that given the project’s scale, complexity and its programme, the circumstances were such as to warrant a deviation from the standard form of Government contract and agreed a derogation from its use.

Reasons for adopting the two-stage process include:

- Early commencement on site, two years ahead of traditional procurement (Phase A works commenced on site on 3 October 2017 and are nearing completion. Finalisation of instruction for Phase B main works in parallel allows these works to commence;

- Market engagement with Irish and international contractors identified this procurement approach would attract increased competition in a situation where there are a very limited number of contractors with the ability to undertake a project of this scale. This was borne out by the competitive nature of the tender process with 5 contractors short-listed for the main contract, 4 for the mechanical installation and 4 for the electrical installation;

- Claims are addressed up front, prior to main construction, rather than as is traditional throughout the project and beyond;

- Reduce exposure to rising inflationary pressures in the construction market through procurement at 2016 tender market rates (versus 2018 tender rates);

- Provide opportunity for the 3 contractors (main contractor and Mechanical & Electrical contractors) to influence/interrogate the detailed design and assume contractual responsibility for completeness including quantities at end of Stage 2 Design;

- The programmes for main works are fully aligned across 3 contractors with a single point accountability for site management.

- Project substantially de-risked in relation to ground conditions with Phase A nearing completion prior to instructing and commencing the main hospital build (Phase B); and

- Incorporation of streamlined dispute resolution including using an independent expert whose decisions are binding on all parties.

A Guaranteed Maximum Price (GMP) is determined prior to the instruction to proceed with the main Phase B works (with the GMP only adjustable for clearly defined exclusions such as changes in scope, excess national construction tender inflation above 4% post July 2019, changes in legislation (e.g. VAT, PRSI, statutory labour rates, building regulations). Other than in respect of exclusions, the GMP ceiling cannot be exceeded with any amount in excess not recoverable by contractors.

Hospital Waiting Lists

Questions (367)

Peter Burke

Question:

367. Deputy Peter Burke asked the Minister for Health if an appointment will be expedited for a person (details supplied). [6373/19]

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Written answers

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, 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.

Child and Adolescent Mental Health Services Staff

Questions (368)

Jackie Cahill

Question:

368. Deputy Jackie Cahill asked the Minister for Health the number of persons working in the child and adolescent mental health services in County Tipperary; the number of positions that are either on leave or vacant, respectively; and if he will make a statement on the matter. [6374/19]

View answer

Written answers

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

Health Services Provision

Questions (369)

Jackie Cahill

Question:

369. Deputy Jackie Cahill asked the Minister for Health if the service at a location (details supplied) in County Cork is to close; if so, the replacement services being provided; and if he will make a statement on the matter. [6375/19]

View answer

Written answers

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

Child and Adolescent Mental Health Services

Questions (370)

Jackie Cahill

Question:

370. Deputy Jackie Cahill asked the Minister for Health his plans to improve the level of child mental health service in County Tipperary; and if he will make a statement on the matter. [6376/19]

View answer

Written answers

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

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