Friday, 6 Sep 2019

Written Answers Nos. 845-869

Nursing Homes Support Scheme

Questions (845)

Peter Burke

Question:

845. Deputy Peter Burke asked the Minister for Health the position regarding charges in a nursing home for a person (details supplied). [34963/19]

Written answers

Minister of State at the Department of Health

The Nursing Homes Support Scheme (NHSS), commonly referred to as A 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 NHSS covers the cost of the standard components of long-term residential care which are:

- Nursing and personal care appropriate to the level of care needs of the person;

- Bed and board;

- Basic aids and appliances necessary to assist a person with the activities of daily living; and

- Laundry service.

A person's eligibility for other schemes, such as the medical card scheme or the drugs payment scheme, is unaffected by participation in the NHSS or residence in a nursing home. Although the NHSS covers core living expenses, residents can still incur some costs in a nursing home, such as social programmes, newspapers, or hairdressing just as they would if they were being cared for at home. Transport to and from medical appointments is not covered under the Scheme.

In recognition of this, anyone in receipt of financial support under the NHSS retains at least 20% of their income. The minimum amount that is retained is the equivalent of 20% of the State Pension (Non-Contributory). An operator should not seek payment from residents for items which are covered by the NHSS, the medical card or any other existing scheme.

Part 7 of the Health Act 2007 (Care and Welfare of Residents in Designated Centres for Older People) Regulations 2013 stipulates that the registered provider of the nursing home must agree a contract in writing with each resident on their admission to the nursing home. This contract must include details of the services to be provided to that resident and the fees to be charged. Residents should never be charged fees which are not set out in the contract. The Department of Health and the HSE are not a party to such contracts which are concluded between each resident and their nursing home.

Registered providers of nursing home care are obliged to provide an accessible and effective complaints procedure. Concerns about additional charges should in the first instance be taken up with the nursing home provider. The Office of the Ombudsman can examine complaints about the actions of a range of public bodies and complaints relating to the administrative actions of private nursing homes. The Office of the Ombudsman normally only deals with a complaint once the individual has already gone through the complaints procedure of the private nursing home concerned.

The Competition and Consumer Protection Commission (CCPC) is an independent statutory body with a dual mandate to enforce competition and consumer protection law in Ireland. CCPC’s mission is to promote competition and enhance consumer welfare. The CCPC has just published consumer protection guidelines for contracts of care in long-term residential care services for older people. The guidelines set out the obligations and responsibilities that providers must adhere to under consumer protection law and are aimed at providing greater transparency, clarity and certainty for consumers.

The Guidelines also set out requirements in relation to transparency regarding additional charges and the variation of charges.

Hospital Waiting Lists

Questions (846)

Stephen Donnelly

Question:

846. Deputy Stephen Donnelly asked the Minister for Health if the case of a person (details suppled) who has been waiting for over four years for an appointment with an orthopaedic consultant at Naas General Hospital will be reviewed; and if he will make a statement on the matter. [34967/19]

Written answers

Minister for 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 Delays

Questions (847)

Pearse Doherty

Question:

847. Deputy Pearse Doherty asked the Minister for Health the reason a person (details supplied) in County Donegal had appointments for a procedure in Galway University Hospital cancelled on four occasions; when a new date for the procedure will be offered; and if he will make a statement on the matter. [34974/19]

Written answers

Minister for Health

Maintaining scheduled care access for all patients is a key priority for hospitals. I fully acknowledge the distress and inconvenience for patients and their families when elective procedures are cancelled, particularly for clinically urgent procedures.

While every effort is made to avoid cancellation or postponement of planned procedures, the HSE advise that planned procedures and operations can be postponed or cancelled for a variety of reasons, including capacity issues due to increased scheduled and unscheduled care demand, medical reasons, and patient choice.

In relation to the specific question raised by the Deputy, as this is a service matter, I have asked the HSE to reply to the Deputy directly.

Medical Aids and Appliances Provision

Questions (848)

Michael Healy-Rae

Question:

848. Deputy Michael Healy-Rae asked the Minister for Health if a neck and head support will be provided for a person (details supplied); and if he will make a statement on the matter. [34981/19]

Written answers

Minister for Health

As this is a service matter it has been referred to the HSE for reply to the Deputy.

Hospital Appointments Status

Questions (849)

Michael Healy-Rae

Question:

849. Deputy Michael Healy-Rae asked the Minister for Health when an operation will be scheduled for a person (details supplied); and if he will make a statement on the matter. [34982/19]

Written answers

Minister for 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.

Cancer Screening Programmes

Questions (850)

Stephen Donnelly

Question:

850. Deputy Stephen Donnelly asked the Minister for Health the productivity levels of cytoscreeners working on behalf of CervicalCheck before and after the judgment in a case (details supplied); and if he will make a statement on the matter. [34991/19]

Written answers

Minister for Health

The Deputy's question relates to service delivery matters, and accordingly I have asked the HSE to respond directly to him.

Cancer Screening Programmes

Questions (851)

Stephen Donnelly

Question:

851. Deputy Stephen Donnelly asked the Minister for Health the staffing levels of cytoscreeners working on behalf of CervicalCheck before and after the judgment in a case (details supplied); and if he will make a statement on the matter. [34992/19]

Written answers

Minister for Health

The Deputy's question relates to service delivery matters, and accordingly I have asked the HSE to respond directly to him.

Medicinal Products Availability

Questions (852)

Eoin Ó Broin

Question:

852. Deputy Eoin Ó Broin asked the Minister for Health the reason immunotherapy treatment is not being provided to cancer patients in public hospitals despite being recommended by oncologists; and if he will review this decision. [34995/19]

Written answers

Minister for Health

A standard assessment process is in place in the HSE for the approval of the reimbursement of new drugs and new indications for existing drugs. This is underpinned by the Framework Agreement on the Supply and Pricing of Medicines (2016) and the Health (Pricing and Supply of Medical Goods) Act 2013. This process is intended to arrive at decisions on the funding of drugs that are clinically appropriate, fair, consistent and sustainable.

New drugs are licensed for use centrally by the European Medicines Agency. Once a drug is licensed the company may apply for HSE reimbursement using the standard process. All cancer drugs approved for reimbursement since 2012 have gone through this process.

The following immunotherapy agents have been approved for reimbursement by the HSE:

- Atezolizumab;

- Avelumab;

- Ipilimumab;

- Nivolumab;

- Nivolumab Ipilimumab; and,

- Pembrolizumab.

The complete list of cancer drugs, including immunotherapies, approved for reimbursement can be found on the HSE website at: https://www.hse.ie/eng/services/list/5/cancer/profinfo/medonc/cdmp/new.html.

Respite Care Services Provision

Questions (853)

Peter Burke

Question:

853. Deputy Peter Burke asked the Minister for Health the position regarding respite hours for a person (details supplied). [35001/19]

Written answers

Minister of State at the Department of Health

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

Cross-Border Health Services Provision

Questions (854)

Peter Burke

Question:

854. Deputy Peter Burke asked the Minister for Health the status of an application for cross-Border funding by a person (details supplied). [35002/19]

Written answers

Minister for Health

As this is a service matter, it has been referred to the Health Service Executive for attention and direct reply to the Deputy.

Hospital Appointments Status

Questions (855)

Peter Fitzpatrick

Question:

855. Deputy Peter Fitzpatrick asked the Minister for Health when a person (details supplied) will receive a hospital appointment. [35012/19]

Written answers

Minister of State at the Department of Health

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

Hospital Appointments Administration

Questions (856)

Niamh Smyth

Question:

856. Deputy Niamh Smyth asked the Minister for Health if he will address concerns (details supplied); if there is a concerted effort by the HSE to keep down referral numbers to consultants at smaller hospitals by issuing such directives; and if he will make a statement on the matter. [35014/19]

Written answers

Minister for Health

As this is a service matter, I have asked the HSE to respond directly to the Deputy.

Hospital Services

Questions (857)

Niamh Smyth

Question:

857. Deputy Niamh Smyth asked the Minister for Health if he will address concerns regarding neurology day services and consultant clinics in counties Cavan and Monaghan; the location and days they take place; his plans to reduce such services in the counties; and if he will make a statement on the matter. [35015/19]

Written answers

Minister for Health

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

Hospital Beds Data

Questions (858)

Niamh Smyth

Question:

858. Deputy Niamh Smyth asked the Minister for Health the number of stepdown beds available at a hospital (details supplied); if the additional six promised for the unit in 2018 have opened; and if he will make a statement on the matter. [35016/19]

Written answers

Minister for Health

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

National Dementia Strategy Implementation

Questions (859)

Denis Naughten

Question:

859. Deputy Denis Naughten asked the Minister for Health his plans to expand the dementia adviser service; and if he will make a statement on the matter. [35017/19]

Written answers

Minister for Health

The National Dementia Strategy requires the HSE to consider the provision of dementia advisers, based on the experience of demonstrator sites. In this context, an evaluation of the Dementia Adviser Service, which was published in September 2018, recommends the continuation and expansion of the service to ensure equity of access countrywide.

The Dementia Adviser Service, established by the Alzheimer Society of Ireland in 2014, covers 12 counties: Cork, Kerry, Tipperary, Limerick, parts of Clare, Galway, Mayo, Sligo, Leitrim, Cavan, Monaghan and Dublin.

Seven ASI Dementia Adviser posts have been funded by the HSE since 2016, with €400,000 allocated by the HSE in each of the last 3 years towards the cost of the service. A commitment has been made to continue this funding in 2019 and in future years.

The level of funding available for the Department of Health in 2020 and the quantum of services to be provided by the HSE, including any plans to expand the Dementia Adviser service, will be considered as part of the national Estimates and budgetary process and National Service Planning.

HSE Properties

Questions (860)

Alan Kelly

Question:

860. Deputy Alan Kelly asked the Minister for Health if the sale of the old St. Felim's hospital building and grounds in Cavan town has been agreed or completed; his views on the decision of the HSE to proceed with the sale despite requests from community and elected representatives for meetings to express their concerns; and if he will make a statement on the matter. [35019/19]

Written answers

Minister for Health

The Health Service Executive (HSE) is responsible for the management of the public healthcare property estate. Details of properties which have been vacated or are due to be vacated are captured as part of the annual service planning strategy. These properties are reviewed for future use and suitability. They may be refurbished immediately, retained for future use or sold.

The HSE operates a protocol for the disposal of surplus property assets, in accordance with Government Policy for Disposal of Surplus Property . This protocol sets out three options:

1 Transfer to another public body or State agency;

2 Open market sale, subject to favourable market conditions;

3 Other uses such as community / voluntary use will be considered only if points 1 and 2 above do not materialise.

Any proposals for the disposal of surplus property assets must be considered in the context of the capital funding available to Health and the Government's Reform Plan relating to the State's property asset use and management. In this context, the HSE is required to obtain value for money when disposing of surplus property assets. These proceeds will be re-invested in delivering much needed health care infrastructure.

I have asked the HSE to respond directly to you in relation to the current status of this property.

Home Help Service

Questions (861)

Niamh Smyth

Question:

861. Deputy Niamh Smyth asked the Minister for Health if the concerns raised by a person (details supplied) regarding the provision of carer's and home help will be reviewed; if the shut down of home help in counties Cavan and Monaghan is connected to the overspend at the national children's hospital; and if he will make a statement on the matter. [35020/19]

Written answers

Minister of State at the Department of Health

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

Hospital Services

Questions (862)

Niamh Smyth

Question:

862. Deputy Niamh Smyth asked the Minister for Health the status of the provision of the 20-week anomaly scan in Cavan General Hospital; if it is open to all women; the days on which it operates; and if he will make a statement on the matter. [35021/19]

Written answers

Minister for Health

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

Emergency Departments

Questions (863)

Niamh Smyth

Question:

863. Deputy Niamh Smyth asked the Minister for Health the status of works planned for the refurbishment of the emergency department at Cavan General Hospital; and if he will make a statement on the matter. [35022/19]

Written answers

Minister for Health

The establishment of Hospital Groups has enabled a better configuration of hospital services with benefits relating to safety, quality, access, cost and sustainable medical staffing. The structure ensures that Hospitals working together in a Group will be able to support each other, providing a stronger role for smaller hospitals in delivering less complex care, and ensuring that those who require emergency or complex planned care are managed safely in larger hospitals.

The Smaller Hospitals Framework focuses in particular on the future role of smaller hospitals and outlines the wide range of services that can be provided within these smaller hospitals. The Department of Health is committed to securing and further developing the role of our smaller hospitals, including Model 3 hospitals such as Cavan Hospital, with the expansion of services delivered in these hospitals, especially in services such as day surgery; ambulatory care; medical services and diagnostics.

Future investment in Cavan General Hospital will be considered within the overall acute hospital infrastructure programme, the prioritised needs of the hospital groups and within the overall capital envelope available to the health service.

Project Ireland 2040 provides €10.9 billion for Health capital developments across the country, including both national programmes and individual projects, across acute, primary and social care. Health capital projects and programmes currently underway will continue. As to be expected with such a plan, many proposals are at an early stage and will require to progress through appraisal, planning design and tender before a firm timeline or funding required can be established.

The planning and management of future health expenditure is considered as part of the annual estimates and budgetary process which seeks to balance available funding across all service areas to achieve the best possible outcomes for the greatest number of service users and prioritise areas of greatest need.

As this is an operational matter, I have asked the Health Service Executive to respond to you directly as soon as possible.

Emergency Departments Data

Questions (864)

Niamh Smyth

Question:

864. Deputy Niamh Smyth asked the Minister for Health the number of attendances at the emergency department in Cavan General Hospital in each of the years 2012 to 2018 and to date in 2019, in tabular form; and if he will make a statement on the matter. [35023/19]

Written answers

Minister for Health

This is a very busy period for our health services, with many hospitals reporting significant numbers of patient attendances. For the first seven months of 2019, the number of patients attending hospital EDs increased by 3.3%, and the number of ED admissions increased by 2.3% compared to the same period last year.

In the first six months of 2019, our health services managed better and the numbers of patients waiting on trolleys nationally were 4.7% lower than for the same period last year despite the significant increase in demand.

However, TrolleyGAR figures show 8,671 people were counted on trolleys in the month of July, which was 21.8% higher than last month (7,120) and 42.5% higher than July 2018 (6,086). Trolley numbers for the year to date from January to July were 62,413, compared to 62,468 for the same period last year.

With regard to the specific question the Deputy has asked, I have asked the HSE to respond directly with the information requested.

Nursing Homes Support Scheme

Questions (865)

Bernard Durkan

Question:

865. Deputy Bernard J. Durkan asked the Minister for Health if the terms of fair deal will be extended retrospectively in the case of a person (details supplied); and if he will make a statement on the matter. [35025/19]

Written answers

Minister of State at the Department of Health

The Nursing Homes Support Scheme is a system of financial support for those in need of long-term nursing home 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.

The Department of Health agree a set level of funding for the NHSS with the HSE each year having regard for the demand for the Scheme and the overall fiscal position. The 2019 budget for the NHSS is €985.8m. State support can only be paid once a financial assessment has been completed and authorised.

The National Guidelines for the Standardised Implementation of the NHSS provide that State Support and the Nursing Home Loan should be paid in respect of qualified applicants from either the date that the application is approved, or date of admission to the nursing home whichever is the later. Therefore in the case where an applicant is already residing in a nursing home when they apply for State support through NHSS this support will be paid from the date that the application is approved and cannot be backdated to the admission date. This is an important governance and control mechanism for the operation of the Scheme.

This provision enables the HSE to manage the budget and commitments under the Scheme over a 12 month period, ensuring that long-term residential care remains accessible and affordable for those that require it.

HSE Reports

Questions (866)

Louise O'Reilly

Question:

866. Deputy Louise O'Reilly asked the Minister for Health if he will address matters regarding a Comptroller and Auditor General report (details supplied); and if he will make a statement on the matter. [35026/19]

Written answers

Minister for Health

The gross cost of acute hospital care as set out in the HSE Annual Report and Financial Statements 2017 incorporates expenditure in relation to all hospital services including emergency departments, inpatient, day case, outpatient services and training programmes for doctors and nurses.

The private patient income reported in the annual financial statements only relates to income invoiced by statutory hospitals. Voluntary hospitals are funded on a net expenditure grant basis by the HSE. The voluntary hospitals only receive funding for expenditure after all income, including private patient income, is taken into account.

There are no private charges by any hospitals in relation to emergency department attendances or out-patient services. In 2017 per the HSE’s published December 2017 Management Data Report there were 1.4m emergency presentations and 3.3m outpatient attendances in the acute hospital system.

The public/private patient split referenced in the C&AG ‘Report on the Accounts of the Public Service 2017’ refers to the 1.7 million inpatient and day case patients discharged from all acute hospitals (statutory and voluntary) in 2017 as reported in the Healthcare Pricing Office 2017 Annual Report. One million of these discharges related to day case patients and 0.6m related to in-patients. Varying costs are applicable in relation to the these different patient categories as reflected in the rate levels applied under the Health (Amendment) Act 2013 as set out below.

Hospital Category	Single Occupancy Rate	Multi Occupancy Rate	Day Case
Hospital specified in the 5th schedule of the Act	€1,000	€813	€407
Hospital specified in the 6th schedule of the Act	€800	€659	€329

These private in-patient charges take account of all the services which a public hospital provides, for example, accommodation, nursing, diagnostics (such as X-rays, CT scans, MRI, etc.) and other overheads and maintenance costs.

The rates currently applied were set for the introduction of the legislation in 2014 and reflected the ‘fully absorbed’ economic cost.

Medicinal Products Reimbursement

Questions (867)

Kate O'Connell

Question:

867. Deputy Kate O'Connell asked the Minister for Health his plans or the plans of the HSE to provide or reimburse ocrelizumab for primary progressive multiple sclerosis patients in view of the decision of the UK (details supplied) [35029/19]

Written answers

Minister for Health

The HSE has statutory responsibility for decisions on pricing and reimbursement of medicines under the community drug schemes, in accordance with the provisions of the Health (Pricing and Supply of Medical Goods) Act 2013; therefore, the matter has been referred to the HSE for reply to the Deputy.

Infectious Diseases

Questions (868)

Gino Kenny

Question:

868. Deputy Gino Kenny asked the Minister for Health if the rules governing public health and exemptions from attendance at court in the case of infectious diseases apply to the family courts; if not, the rationale for same; if he will consider a revision (details supplied); and if he will make a statement on the matter. [35030/19]

Written answers

Minister for Health

This relates to a matter that arose during a case in the Family Courts. While Section 30 of the Health Act 1947 does impose certain obligations on persons or probable sources of infection of infectious diseases, decisions regarding attendance at the Court is a matter for the Court to make.

Policy responsibility regarding Court Services is a matter for the Department of Justice and Equality.

Hospital Appointments Status

Questions (869)

Bernard Durkan

Question:

869. Deputy Bernard J. Durkan asked the Minister for Health when an appointment for an assessment in respect of a scoliosis procedure will be offered in the case of a person (details supplied); and if he will make a statement on the matter. [35031/19]

Written answers

Minister for 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.