Nursing Home Subventions

Questions (677)

Jan O'Sullivan

Question:

677. Deputy Jan O'Sullivan asked the Minister for Health his plans to introduce changes to the fair deal scheme; if the changes will include examining the effect of the sale or rental of the home of the person applying for the scheme which has led to many homes being left empty in the midst of a shortage of supply of homes nationally; and if he will make a statement on the matter. [18638/19]

View answer

Written answers (Question to Health)

The Nursing Homes Support Scheme (NHSS), commonly referred to as Fair Deal, is a system of financial support for people who require long-term residential care. Participants contribute to the cost of their care according to their means while the State pays the balance of the cost. The Scheme aims to ensure that long-term nursing home care is accessible and affordable for everyone and that people are cared for in the most appropriate settings.

Participants in the Scheme contribute up to 80% of their assessable income, such as their pension and a maximum of 7.5% per annum of the value of assets held, such as their principal private residence or cash assets. The first €36,000 of an individual’s assets is not counted at all in the financial assessment. The capital value of an individual’s principal private residence is only included in the financial assessment for the first three years of their time in care. This is known as the three year cap.

The Scheme has no restrictions in place in relation to the sale of a home. However, if a participant in the Scheme were to sell an asset, such as a home, after their first financial assessment the proceeds of the sale would therefore become a cash asset. The three-year cap will then no longer apply and the participant must pay a contribution of 7.5% based on this cash asset.

A participant in the scheme can request a financial review if 12 months have passed since their initial review. However, the HSE may review a financial assessment at any stage.

Under the NHSS rental income is considered income for the purpose of the financial assessment of means and is assessed at 80% less any allowable deductions.

Action 17 of the Strategy for the Rental Sector commits the Department of Housing, Planning, and Local Government (DHPLG) to examine the treatment under the Nursing Homes Support Scheme's financial assessment of income from the rental of a person's principal private residence where they move into long term residential care. The Department of Health is currently engaging with the DHPLG in this regard to examine the policy and legal implications on this issue. Any changes to the treatment of rental income under the Scheme require careful policy analysis and consideration, particularly with regard to any impact on the sustainability of the Scheme. If changes were to be proposed primary legislation would be required to give effect to them. Work will continue on this issue throughout 2019.

Emergency Departments Services

Questions (678)

Willie O'Dea

Question:

678. Deputy Willie O'Dea asked the Minister for Health his views on whether increasing the size of the emergency department in University Hospital Limerick has led to extra admissions; if not, the reason for same; and if he will make a statement on the matter. [18645/19]

View answer

Written answers (Question to Health)

The Emergency Department in University Hospital Limerick is one of the busiest in the country, with the number of patients attending growing year on year.

The decision to admit a patient is a clinical decision. Therefore, I have the asked the HSE to provide a reply to the Deputy directly on this matter.

Hospital Accommodation Provision

Questions (679)

Willie O'Dea

Question:

679. Deputy Willie O'Dea asked the Minister for Health if the same bed management process being used in Beaumont Hospital is being considered for University Hospital Limerick; and if he will make a statement on the matter. [18646/19]

View answer

Written answers (Question to Health)

As this is a service issue, I have asked the HSE to reply to you directly.

HSE Staff

Questions (680)

Joan Burton

Question:

680. Deputy Joan Burton asked the Minister for Health if his Department was consulted on the publicly indicated recruitment and overtime ban to be brought in by the Health Service Executive; and if he will make a statement on the matter. [18020/19]

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Written answers (Question to Health)

There is no recruitment and overtime ban in place in the HSE. However, in recent months, officials from my Department have been engaging intensively with the HSE in reaching agreement on a Pay and Numbers Strategy for 2019. The key focus in developing the strategy is to ensure that affordable and appropriate recruitment decisions are made by the HSE and that they need to operate within its pay allocations.

By the end of 2018, the levels of agency, overtime and pay costs had reached unaffordable levels. In light of this, the HSE decided to introduce interim control measures for a consolidation period of three months to the end of June, until they received clarity on plans and financial performance for Q1 2019 from Hospital Groups and CHO’s.

I have been very clear that those locations which provide credible, balanced plans will be supported. Similarly, locations which do not submit such plans need to be scrutinised. It should also be noted that the HSE is continuing to recruit all funded development posts.

Medicinal Products Reimbursement

Questions (681)

Charlie McConalogue

Question:

681. Deputy Charlie McConalogue asked the Minister for Health the position regarding the assessment on the provision of a drug (details supplied); and if he will make a statement on the matter. [18650/19]

View answer

Written answers (Question to Health)

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

As Minister for Health, I do not have any statutory power or function in relation to the reimbursement of medicines.

I am advised by the HSE that the National Centre for Pharmacoeconomics has not received a submission from the applicant company to date. The submission of a dossier by the applicant company is the next required step. Unless the dossier is submitted by the applicant, it will not be possible to progress this application.

Details in relation to the commissioned assessment and previous assessments of this medicine are available on the NCPE website.

HSE Expenditure

Questions (682)

Jan O'Sullivan

Question:

682. Deputy Jan O'Sullivan asked the Minister for Health the amount spent on taxis by the Health Service Executive in the most recent year for which figures exist by each community healthcare organisation area; and if he will make a statement on the matter. [18657/19]

View answer

Written answers (Question to Health)

As the Health Service Executive is responsible for operational matters, I have asked the HSE to respond to you directly in relation to this matter.

Maternity Services

Questions (683)

Jan O'Sullivan

Question:

683. Deputy Jan O'Sullivan asked the Minister for Health the progress in the implementation of the National Maternity Hospital strategy; if the budget to roll out the strategy has been ring-fenced as originally intended in order to ensure the continuing roll out of the 77 actions contained in the strategy; and if he will make a statement on the matter. [18660/19]

View answer

Written answers (Question to Health)

Implementation of the National Maternity Strategy is continuing, led by the HSE National Women and Infants Health Programme (NWIHP). The Strategy represents a significant development in the delivery of national maternity policy that will fundamentally change how maternity care is delivered in this country. In 2016, the year the Strategy was launched, development funding of €3m was provided for maternity services. This was followed by increased funding of €6.8m in 2017. In 2018, €4.15m development funding was allocated to the NWIHP to progress the Strategy. Funding of €3.1m is being made available to the NWIHP in 2019 to continue services introduced in 2018, along with an additional €1m funding to further progress the Strategy.

Funding allocated to-date for the Strategy’s implementation, has helped to improve the quality and safety of our maternity services through the recruitment of additional midwives, consultants, theatre staff, ultrasonographers and quality and safety managers, by increasing access to routine anomaly scanning and through the continued roll-out of the Maternal and Newborn Clinical Management System. My Department will continue to work with the NWIHP in 2019 to support ongoing implementation of the Strategy.

Assisted Human Reproduction Services Provision

Questions (684, 853, 865, 872, 955)

Catherine Murphy

Question:

684. Deputy Catherine Murphy asked the Minister for Health the status of financial assistance for persons seeking IVF treatments; the date on which financing persons for same will commence in 2019; the way in which the application process will be governed; the eligibility criteria for the scheme; and if he will make a statement on the matter. [18666/19]

View answer

Michael Lowry

Question:

853. Deputy Michael Lowry asked the Minister for Health the status of financial support for couples that have to pay for IVF; and his plans in this regard. [19318/19]

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Peter Burke

Question:

865. Deputy Peter Burke asked the Minister for Health the status of the provision of IVF through the public health system; when persons will be able to apply for same; the criteria in order to apply for same; and if he will make a statement on the matter. [19361/19]

View answer

Louise O'Reilly

Question:

872. Deputy Louise O'Reilly asked the Minister for Health the funding streams that have been created and are available for couples in regard to IVF in view of comments by the Taoiseach in 2018 (details supplied). [19376/19]

View answer

Micheál Martin

Question:

955. Deputy Micheál Martin asked the Minister for Health if he will report on the €1 million that has been allocated to assist infertile couples access IVF in 2019; the criteria being used for same; if funding has been spent to date; the number of couples it will assist in 2019; and if he will make a statement on the matter. [19687/19]

View answer

Written answers (Question to Health)

I propose to take Questions Nos. 684, 853, 865, 872 and 955 together.

In October 2017, the Government approved the drafting of a Bill on assisted human reproduction (AHR) and associated areas of research, based on the published General Scheme of the Assisted Human Reproduction Bill. The Joint Oireachtas Committee on Health is currently conducting a review of the General Scheme as part of the pre-legislative scrutiny process, which began in January of last year. The Joint Committee intends to report thereon before the summer recess and the recommendations in its report will be considered during the ongoing process of drafting this Bill in conjunction with the Office of the Attorney General.

Interlinked with the legislation, officials in my Department, in conjunction with the HSE, are developing a model of care for infertility and an associated public fund for AHR. This work includes developing proposals on the allocation of the €1 million fund for use in relation to providing public AHR treatment which was announced in December 2018.

Accordingly, options in relation to the parameters of any potential public funding model, including what eligibility criteria may be included, are still under consideration, and an announcement will be forthcoming once the relevant decisions have been finalised.

It should be noted that while AHR treatment is not currently funded by the Irish Public Health Service there is some support available in that patients who access IVF treatment privately may claim tax relief on the costs involved under the tax relief for medical expenses scheme. In addition, a defined list of fertility medicines needed for fertility treatment is covered under the High Tech Arrangements administered by the HSE. Medicines covered by the High Tech Arrangements must be prescribed by a consultant/specialist and authorised for supply to the client’s nominated community pharmacy by the High Tech Hub managed by the Primary Care Reimbursement Service. The cost of the medicines is then covered, as appropriate, under the client’s eligibility, i.e., Medical Card or Drugs Payment Scheme.

Overall, the development of a model of care for infertility will help to ensure the provision of safe, effective and accessible services through the public health system as part of the full range of services available in obstetrics and gynaecology.

Hospitals Policy

Questions (685)

Clare Daly

Question:

685. Deputy Clare Daly asked the Minister for Health further to parliamentary question No. 629 of 26 March 2019, the reason none of the hospitals in question use the CPE outbreak control checklist 1.0 for guidance in dealing with CPE outbreaks, nor do they maintain a record for the purposes of accountability and audit of recommended control actions taken; and his views on the lack of accountability or audit trail in regard to this issue. [18669/19]

View answer

Written answers (Question to Health)

I have referred the Deputy's question to the HSE for direct reply.

Psychological Services

Questions (686)

David Cullinane

Question:

686. Deputy David Cullinane asked the Minister for Health the additional child psychologist posts that have been created in the past five years in the community healthcare organisation area for the south east by year and county in tabular form; and if he will make a statement on the matter. [18670/19]

View answer

Written answers (Question to Health)

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

Speech and Language Therapy Provision

Questions (687)

David Cullinane

Question:

687. Deputy David Cullinane asked the Minister for Health the additional speech and language therapist posts that have been made in the past five years in the community healthcare organisation area for the south east by year and by county in tabular form; and if he will make a statement on the matter. [18671/19]

View answer

Written answers (Question to Health)

I have asked the HSE to respond to the Deputy directly on this matter.

Occupational Therapy Provision

Questions (688)

David Cullinane

Question:

688. Deputy David Cullinane asked the Minister for Health the additional occupational therapists posts that have been created in the past five years in the CHO area for the south-east by year and county in tabular form; and if he will make a statement on the matter. [18672/19]

View answer

Written answers (Question to Health)

I have asked the HSE to respond to the Deputy directly on this matter.

Disabilities Assessments

Questions (689, 690)

David Cullinane

Question:

689. Deputy David Cullinane asked the Minister for Health the average wait times for child psychologists, child speech and language therapists and child occupational therapists in the community healthcare organisation area for the south east by year and county in tabular form; and if he will make a statement on the matter. [18673/19]

View answer

David Cullinane

Question:

690. Deputy David Cullinane asked the Minister for Health the assessment teams in place to access children in the community healthcare organisation area for the south east by county in tabular form; and if he will make a statement on the matter. [18674/19]

View answer

Written answers (Question to Health)

I propose to take Questions Nos. 689 and 690 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 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.

Services for People with Disabilities

Questions (691)

Gino Kenny

Question:

691. Deputy Gino Kenny asked the Minister for Health if the creation of an additional position for a cognitive behavioural therapy practitioner in the city north-east sector (details supplied) will be considered; and if he will make a statement on the matter. [18675/19]

View answer

Written answers (Question to Health)

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

Medicinal Products Availability

Questions (692)

Tony McLoughlin

Question:

692. Deputy Tony McLoughlin asked the Minister for Health when the Health Service Executive plans to provide the pembrolizumab drug to public cancer patients; and if he will make a statement on the matter. [18680/19]

View answer

Written answers (Question to Health)

The HSE has statutory responsibility for medicine pricing and reimbursement decisions, in accordance with the Health (Pricing and Supply of Medical Goods) Act 2013. As Minister for Health, I do not have any statutory power or function in relation to the reimbursement of medicines.

In Ireland the majority of patients access medicines through the publicly funded Community Drug Schemes.

In line with the 2013 Act and the national framework agreed with industry, if a company would like a medicine to be reimbursed by the HSE, it must apply to have the new medicine added to the reimbursement list.

Reimbursement is for licensed indications which have been granted market authorisation by the European Medicines Agency (EMA) or the Health Products Regulatory Authority (HPRA).

HSE decisions on which medicines are reimbursed by the taxpayer are made on objective, scientific and economic grounds, on the advice of the National Centre for Pharmacoeconomics (NCPE).

Pembrolizumab has market authorisation in Ireland/the EU for a number of indications.

The HSE has approved the reimbursement of Pembrolizumab for the following indications:

- as monotherapy for the treatment of advanced (unresectable or metastatic) melanoma in adults;

- as monotherapy for the first-line treatment of metastatic non-small cell lung carcinoma (NSCLC) in adults whose tumours express PD-L1 with a more than or equal to 50% tumour proportion score (TPS) with no EGFR or ALK positive tumour mutations;

- as monotherapy for the treatment of adult patients with relapsed or refractory classical Hodgkin lymphoma (cHL) who have failed autologous stem cell transplant (ASCT) and brentuximab vedotin (BV), or who are transplant-ineligible and have failed BV.

It should be noted that the first part of the last indication is not reimbursed because the HSE is already reimbursing another immunotherapy with similar efficacy (nivolumab) at lower cost. Patients who are transplant-ineligible and have failed BV can receive reimbursement support for pembrolizumab, as nivolumab does not have market authorisation for this sub-group of patients.

The HSE Drugs Group are reviewing the indication below:

- as monotherapy for the treatment of locally advanced or metastatic urothelial carcinoma in adults who are not eligible for cisplatin-containing chemotherapy and whose tumours express PD-L1 with a combined positive score (CPS) 10.

The following indications are currently under health technology assessment with the NCPE:

- in combination with pemetrexed and platinum chemotherapy, for the first-line treatment of metastatic non-squamous NSCLC in adults whose tumours have no EGFR or ALK positive mutations;

- as monotherapy for the treatment of locally advanced or metastatic urothelial carcinoma in adults who have received prior platinum-containing chemotherapy.

No reimbursement application has been received to date for the following indication:

- as monotherapy for the treatment of recurrent or metastatic head and neck squamous cell carcinoma (HNSCC) in adults whose tumours express PD-L1 with a 50% TPS and progressing on or after platinum-containing chemotherapy .

However, the HSE has approved reimbursement of nivolumab for the treatment of recurrent or metastatic squamous cell cancer of the head and neck in adults progressing on or after platinum-based therapy.

In October 2018, the HSE commissioned a rapid review assessment for the indication below:

- as monotherapy for the adjuvant treatment of adults with stage III melanoma and lymph node involvement who have undergone complete resection.

The NCPE have recommended a full HTA to assess the clinical effectiveness and cost effectiveness of pembrolizumab compared with the current standard of care.

There are no other indications for pembrolizumab approved in the European Union at this time.

Clinical trials for various immunotherapies, including pembrolizumab, are ongoing globally for a range of other possible indications, which may receive marketing authorisation in the EU over the next number of years. Each of those indications will be considered for reimbursement as market authorisations are granted and applications received.

Primary Care Centres Provision

Questions (693)

Pearse Doherty

Question:

693. Deputy Pearse Doherty asked the Minister for Health the status of plans to develop a primary care centre (details supplied) in County Donegal; if the existing facility which houses general practitioner and related health services in the area remains available for use in the immediate to medium term; and if he will make a statement on the matter. [18681/19]

View answer

Written answers (Question to Health)

As 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.

Hospital Appointments Status

Questions (694)

Pearse Doherty

Question:

694. Deputy Pearse Doherty asked the Minister for Health when a person (details supplied) in County Donegal can expect to receive an appointment in Letterkenny University Hospital; and if he will make a statement on the matter. [18682/19]

View answer

Written answers (Question to Health)

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 Appointments Status

Questions (695)

Pearse Doherty

Question:

695. Deputy Pearse Doherty asked the Minister for Health when a person (details supplied) in County Donegal can expect to receive an appointment in Letterkenny University Hospital; and if he will make a statement on the matter. [18683/19]

View answer

Written answers (Question to Health)

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 Staff Data

Questions (696)

Willie O'Dea

Question:

696. Deputy Willie O'Dea asked the Minister for Health the number of nurses on duty in the emergency department in University Hospital Limerick at 8 a.m. on 3 April 2019; and if he will make a statement on the matter. [18695/19]

View answer

Written answers (Question to Health)

As this is a service issue, I have asked the HSE to reply to you directly.

Hospital Appointments Administration

Questions (697)

Carol Nolan

Question:

697. Deputy Carol Nolan asked the Minister for Health when a person (details supplied) had a recent surgical appointment deferred at a hospital, will receive an appointment; and if the appointment will be expedited. [18697/19]

View answer

Written answers (Question to Health)

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.

Health Services Provision

Questions (698, 699, 700, 703, 704, 705, 706)

Carol Nolan

Question:

698. Deputy Carol Nolan asked the Minister for Health the actions he has taken to assist women injured by vaginal mesh; and if he will make a statement on the matter. [18720/19]

View answer

Carol Nolan

Question:

699. Deputy Carol Nolan asked the Minister for Health if funding will be made available to women injured by vaginal mesh implants in order to enable them to travel to the UK to have mesh removed by consultants with extensive experience in the UK. [18721/19]

View answer

Carol Nolan

Question:

700. Deputy Carol Nolan asked the Minister for Health if he will meet with women injured by vaginal mesh here. [18722/19]

View answer

Carol Nolan

Question:

703. Deputy Carol Nolan asked the Minister for Health the reason there is unclear, disjointed and delayed communication between the personnel operating the pathways programme and women affected by mesh complications; and if he will make a statement on the matter. [18725/19]

View answer

Carol Nolan

Question:

704. Deputy Carol Nolan asked the Minister for Health if a review of the pathways programme in respect of its role to assist women injured by mesh here is being considered; and if he will make a statement on the matter. [18726/19]

View answer

Carol Nolan

Question:

705. Deputy Carol Nolan asked the Minister for Health the reason the National Mesh Advisory Group has refused to meet with women injured by mesh. [18727/19]

View answer

Carol Nolan

Question:

706. Deputy Carol Nolan asked the Minister for Health the steps he will take to ensure that the National Mesh Advisory Group meets with women injured by mesh as soon as possible in the interest of their health; and if he will make a statement on the matter. [18728/19]

View answer

Written answers (Question to Health)

I propose to take Questions Nos. 698 to 700, inclusive, and 703 to 706, inclusive, together.

As 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 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 & Infants Health Programme at smi.nwihp@hse.ie.

I am informed that an ongoing work programme for the clarification and development of treatment pathways and appropriate referral services for women suffering from mesh-related complications is being progressed through this Group. This work includes 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 is also examining 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 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.

As was requested by the Secretary General of my Department in November 2018, the HSE has prepared an Implementation Plan for the complete set of recommendations set out in the CMO’s Report, which was approved by the Leadership Team in the HSE and published on the HSE website on 26 April 2019, which I hope provides further clarity on this issue.

I am informed that the HSE has advised that a detailed progress report on implementation of the recommendations will be provided to my Department by 30 June 2019.

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.

Hospital Services

Questions (701)

Carol Nolan

Question:

701. Deputy Carol Nolan asked the Minister for Health the reason women suffering from vaginal mesh complications have recently been informed by a hospital (details supplied) that they must wait in excess of 52 weeks for gynaecology services at the hospital. [18723/19]

View answer

Written answers (Question to Health)

As the Deputy's question relates to an operational issue, I have referred the matter to the HSE for direct reply.