Written Answers Nos. 130-149
130. Deputy Bríd Smith asked the Minister for Health if a person (details supplied) will be allowed to give evidence to the vaginal mesh review team in the interest of transparency and fairness in view of the fact that another person gave evidence. [16866/19]
View answerAs Minister for Health, I requested Dr Tony Holohan, Chief Medical Officer (CMO) to draft a report on the use of Uro-Gynaecological Mesh in the surgical treatment of stress urinary incontinence (SUI) and pelvic organ prolapse (POP) in women. The report covers the clinical and technical issues involved in ensuring both:
1. the safe and effective provision of mesh procedures in urogynaecology and
2. an appropriate response to women who suffer complications as a result of undergoing such procedures.
This report has been completed and was published on the Department of Health website on 21 November 2018. Preparation of the report involved consultation and engagement with national and international bodies, including the Health Products Regulatory Agency (HPRA); the relevant professional training bodies, the Institute of Obstetricians and Gynaecology (IOG) and the Royal College of Surgeons in Ireland (RCSI); the Continence Foundation of Ireland (CFI) and the Health Service Executive (HSE), as well as colleagues in other jurisdictions. The report was informed by review of international reports and safety reviews of mesh surgery which have been published in recent years.
The report was informed by the personal experiences and concerns of women who have suffered complications following mesh surgery, including through written representations to me and my Department, those concerns raised in Parliamentary Questions on this subject, and the issues raised by the Mesh Survivors Ireland group at its meeting with me on 14 June 2018. I acknowledge the bravery, commitment and dignity shown by the women I met and by those women who have written to me concerning this issue, in sharing what were often harrowing, deeply personal experiences.
The priority issues relating to patient care which were raised by women suffering complications and by others on their behalf are addressed in the report recommendations and are being addressed by the HSE.
It is important to note that the views of the many women who have undergone mesh procedures and have had satisfactory outcomes, with minor or no complications, were not formally sought and so are not reflected in this report. Also, following the implementation of a pause in mesh procedures by the HSE in July 2018, a number of women whose procedures were postponed wrote to me and my Department expressing concern at the impact that this is having on them personally as they await treatment for the distressing symptoms of SUI, reflecting another important group of women affected directly by this issue.
The CMO’s Report identifies that for many women, surgical procedures using synthetic mesh devices have provided a more effective and less invasive form of treatment than traditional SUI and POP procedures. However, mesh devices are associated with significant and severe complications in a minority of women. These are of concern given the difficulties of mesh implant removal.
The Report makes 19 recommendations including:
- the development of patient information and informed consent materials;
- surgical professional training and multidisciplinary expertise in units carrying out mesh procedures;
- the development of clinical guidance;
- the development of information systems to monitor the ongoing use of mesh devices;
- ensuring the reporting of mesh related complications; and
- ensuring timely, appropriate and accessible care pathways for the management of women with complications.
In advance of the report’s completion, the HSE was requested in May 2018 to begin work immediately on the development of national standardised patient information and informed consent materials and the clarification and development of treatment pathways and appropriate referral services for women suffering serious complications. The HSE was also asked by the Chief Medical Officer on 24 July to pause all mesh procedures where clinically safe to do so, until a number of key recommendations are implemented.
A Synthetic Mesh Devices Advisory Group has been convened by the HSE, to advise on and progress all of the recommendations. The Group 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 above. The HSE has advised that it is unable to facilitate membership on the Advisory Group to every patient or patient group who has a mesh experience. The NWIHP has sought to have a range of mesh experiences from the patient’s perspective represented by a patient advocate on the Group – including patients who have had mesh with post-operative problems, patients who have had successful mesh surgery and patients who are on the waiting list for a mesh procedure. The HSE advises that women who wish to submit views or submissions to the overall work of the Group should contact the National Women and Infants Health Programme at smi.nwihp@hse.ie.
I am informed that an ongoing work programme for the development of appropriate patient information resources and consent materials, and the clarification and development of treatment pathways and appropriate referral services for women suffering from mesh-related complications is being progressed through this Group. The work being progressed by the HSE will include identifying the appropriate specialist clinical expertise and facilities required at hospital group level and nationally to provide comprehensive aftercare services. Pending the completion of this, the HSE will also examine the need to look at sourcing services from abroad to address any immediate shortfalls identified, either through utilisation of the treatment abroad scheme or by commissioning services from abroad.
The HSE has advised that many women have already engaged with this pathway system and have attended centres for second opinion and follow up appointments. The HSE has published a dedicated webpage about vaginal mesh implants, including contact information for women suffering complications, which I hope is a useful resource. This can be found on the HSE website.
The Secretary General of my Department wrote to the HSE on November 27 2018 to request that it prepare a detailed Implementation Plan for the complete set of recommendations set out in the CMO’s Report, to be approved by the Leadership Team in the HSE and published on the HSE website within three months of receipt of the report, or sooner if completed. It was also requested that a copy of the Implementation Plan, together with an interim report on the implementation of those recommendations on which work has already commenced, should be submitted to the Department at the time of publication of the Implementation Plan.
I am informed that the HSE has advised that the final version of the Implementation Plan will be published on its website and submitted to my Department in coming weeks.
At my recent meeting with the Mesh Survivors Ireland Group on 7 March 2019 I agreed to continue engagement with them on a pathway forward, to ensure that the ongoing clinical management of this patient group is in line with international best practice and emerging evidence.
131. Deputy Niamh Smyth asked the Minister for Health the reason charges have been implemented in the case of a person (details supplied) when the service user has a free travel pass; if he will instruct the HSE to reverse its decision to implement both charges; and if he will make a statement on the matter. [16869/19]
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.
132. Deputy Imelda Munster asked the Minister for Health the position regarding the removal of the venesection inpatient day case charge of €80 for patients with hereditary haemochromatosis; if a decision has been made; and if he will make a statement on the matter. [16872/19]
View answerThe Health Act 1970 (as amended) provides that all people ordinarily resident in Ireland are entitled, subject to certain charges, to public in-patient hospital services including consultant services and to public out-patient hospital services. Under Section 52 of the Health Act 1970, as amended by Section 12 of the Health (Amendment) Act 2013, a person who has been referred to a hospital for an in-patient service, including that provided on a day case basis, will have to pay the statutory daily charge, currently €80 per day, up to a maximum of €800 per year.
On this basis, where venesection is classed as a day case procedure and is not carried out in an out-patient setting, the public in-patient charge applies.
The issue of the provision of therapeutic phlebotomy services for hereditary haemochromatosis patients, including the issue of charges, is currently under consideration by my Department and the HSE.
It is agreed that such services should be provided at the lowest level of complexity that is clinically and operationally feasible. In time it is envisaged that the majority of this work will be done in a primary care setting.
133. Deputy Tony McLoughlin asked the Minister for Health when construction will commence on the new Sheil Community Hospital in Ballyshannon, County Donegal; and if he will make a statement on the matter. [16875/19]
View answerAs the Health Service Executive is responsible for the delivery of healthcare infrastructure projects, I have asked the HSE to respond to provide you directly with the current position regarding the development of a new community nursing unit in Ballyshannon Co. Donegal.
134. Deputy Niamh Smyth asked the Minister for Health the reason the family of a person (details supplied) was not provided with home help following the discharge of a parent from hospital on the second occasion; if home help will be granted in the case; and if he will make a statement on the matter. [16876/19]
View answerAs this is a service matter I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.
135. Deputy Niamh Smyth asked the Minister for Health if he will contact mental health services within the HSE locally to link in with the family of a person (details supplied); and if he will make a statement on the matter. [16877/19]
View answerAs this is a service matter I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.
136. Deputy John Brady asked the Minister for Health the position regarding the development of primary care centres in Greystones and Arklow, County Wicklow further to the announcement of a developer (details supplied) not to proceed with the Arklow centre; the impact this will have on the development of both centres and the planned timeframe; and if he will make a statement on the matter. [16878/19]
View answerAs the HSE has responsibility for the provision, along with the maintenance and operation of Primary Care Centres and other Primary Care facilities, the Executive has been asked to reply directly to the Deputy.
137. Deputy Niamh Smyth asked the Minister for Health if a special bed can be assigned in the case of a person (details supplied); and if he will make a statement on the matter. [16879/19]
View answerAs this is a service matter it has been referred to the HSE for direct reply to the Deputy.
138. Deputy Denis Naughten asked the Minister for Health the building and other capital spend on each site in the Saolta Hospital Group in each of the past five years; and if he will make a statement on the matter. [16880/19]
View answerAs the Health Service Executive is responsible for the delivery of healthcare infrastructure projects, I have asked the HSE to respond to you directly in relation to this matter.
139. Deputy James Browne asked the Minister for Health the steps he has taken to address the problem of holders of medical cards receiving charges for blood tests; and if he will make a statement on the matter. [16882/19]
View answerUnder 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.
140. Deputy Catherine Murphy asked the Minister for Health the number of children or persons under 18 years of age awaiting assessment of need by county and year of referral for assessment, in tabular form; and if he will make a statement on the matter. [16889/19]
View answer141. Deputy Catherine Murphy asked the Minister for Health the number of children or persons under 18 years of age awaiting treatment following an assessment of need by county and year of referral, in tabular form; and if he will make a statement on the matter. [16890/19]
View answerI propose to take Questions Nos. 140 and 141 together.
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 questions relate to service matters, I have arranged for them to be referred to the Health Service Executive (HSE) for direct reply to the Deputy.
142. Deputy John Curran asked the Minister for Health when a project for a primary care centre (details supplied) will go to tender; the timeframe for construction to commence and the centre to be operational; and if he will make a statement on the matter. [16892/19]
View answerAs the Health Service Executive is responsible for the delivery of healthcare infrastructure projects, I have asked the HSE to respond to you directly in relation to this matter.
143. Deputy Aindrias Moynihan asked the Minister for Health the number of persons removed from hospital waiting lists in County Cork for orthopaedic, ophthalmological and gynaecological services for failing to respond to a validation letter in the past 18 months; the number of those persons back on those waiting lists, in tabular form; and if he will make a statement on the matter. [16893/19]
View answerGood practice around the management of hospital waiting lists recommends periodic validation of waiting lists. Validation is the process whereby hospital administration contacts patients on waiting lists at pre-planned intervals during the year to ensure that patients are ready, willing, suitable and available to attend a hospital appointment or wish to be removed.
Importantly, the validation process allows for situations where, if requested by the GP/referring clinician, patients can be reinstated back to their original place on to the Waiting List.
Last year, I approved the establishment of a Central Waiting List Validation Office within the NTPF. The new office delivers a standardisation of approach to validation across all waiting lists and all hospitals in line with the best patient-centred practices. The validation of waiting lists better informs the true demand for hospital services and enable improved efficiency and patient scheduling.
In relation to the particular query raised, as this is a service matter, I have asked the HSE to respond to the Deputy directly.
144. Deputy Jan O'Sullivan asked the Minister for Health the status of the recruitment process for a multiple sclerosis clinical nurse specialist in University Hospital Limerick; and if he will make a statement on the matter. [16903/19]
View answerAs this is a service issue, I have asked the HSE to reply to you directly.
145. Deputy Brendan Ryan asked the Minister for Health the number of National Ambulance Service bases nationally; the number that have ambulance dispatch 24 hours a day 365 days a year; the ambulance stations that do not have full ambulance dispatch 24 hours a day 365 days a year; the times each week that such dispatch is not available; and if he will make a statement on the matter. [16917/19]
View answerAs this is a service issue, I have asked the HSE to reply to you directly.
146. Deputy Brendan Ryan asked the Minister for Health further to Parliamentary Questions Nos. 380 and 396 of 26 February 2019, if the HSE has finalised its capital plan for 2019 and submitted it for approval; if not, when it is expected; if so, when it will be approved; and if he will make a statement on the matter. [16921/19]
View answerThe Health Service Executive is currently developing its Capital Plan for 2019. My Department and the HSE are in discussion in respect to capital funding in 2019 and subsequent years as part of a process of engagement to finalise the HSE Capital Plan for 2019.
Once the HSE has finalised its Capital Plan for 2019, it will then be submitted to me for approval with the consent of the Minister for Public Expenditure and Reform.
147. Deputy Róisín Shortall asked the Minister for Health the status of the introduction of minimum unit pricing for alcohol; and the timescale to which he is working. [16937/19]
View answerThe Government Decision in 2013 approved the implementation of a minimum unit pricing regime for alcohol products under the Public Health (Alcohol) Bill to be subject to a similar provision being introduced simultaneously in Northern Ireland. Government approval will be sought to introduce the measure in this jurisdiction only. Section 11 (1) of the Act sets out the minimum price per gram of alcohol at €0.10. The Minister for Health intends to implement MUP as soon as possible in order to address the health harms and financial costs associated with harmful alcohol consumption.
148. Deputy Róisín Shortall asked the Minister for Health the criteria on which the allocation of the funding will be based in respect of the additional funding of €1 million for the national drugs strategy, the €250,000 for the community alcohol programme and the €250,000 for young people at risk; and if he will make a statement on the matter. [16938/19]
View answerOn 06 March 2019, I announced additional funding of €1 million for the implementation of the National Drugs Strategy; "Reducing Harm, Supporting Recovery". This funding, which will be provided on a recurring, multi-annual basis, will address the priorities set down in the Strategy including early harm reduction responses, emerging trends in substance misuse, and improving services for at-risk groups.
Working in partnership with statutory, community and voluntary sectors is central to this response. On 26 March, I met with the Local and Regional Drug and Alcohol Task Forces, and the HSE, to hear their views on how best to target the additional funding. The outcome of this consultation process will inform proposals, currently being developed, for the allocation of the funding. Further information on the criteria and proposed allocation of this new funding will be circulated to the Drug & Alcohol Task Forces and the HSE in due course.
This year my Department will also develop two new schemes to deliver an integrated public health approach to drugs and alcohol, as set out in the National Drugs Strategy. The first will provide targeted, appropriate and effective services for young people at risk of substance abuse, focused on disadvantaged communities. The second will support evidence-based approaches to mobilising community action on alcohol. Both schemes will have a fund of €250,000 on a multi-annual basis.
149. Deputy Róisín Shortall asked the Minister for Health his views on the recent decision by a company (details supplied) to pull out of Ireland; the number of primary care centres affected by the decision; the location of each; the stage at which each of these is at; the way in which he plans to proceed in respect of each; and if he will make a statement on the matter. [16943/19]
View answerAs the HSE has responsibility for the provision, along with the maintenance and operation of Primary Care Centres and other Primary Care facilities, the Executive has been asked to reply directly to the Deputy.
