Departmental Expenditure

Questions (408)

Barry Cowen

Question:

408. Deputy Barry Cowen asked the Minister for Health further to Parliamentary Question No. 173 of 22 October 2019, the amount of this change that stems from increased pay and allowances; the amount owing to maintaining existing levels of service; the amount for demographic changes; the amount for the provision of new and expanded services; and if he will make a statement on the matter. [44595/19]

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Written answers (Question to Health)

The current government has maintained its commitment to investment in health services since 2016. Each year the Health Service Executive sets out in its National Service Plan the allocation of the funding received from government for the delivery of health services for the year.

From the following table the Deputy will see the majority of the funding has been allocated to pay cost pressures and maintaining existing levels of service, taking account of demographic changes. These allocations are balanced with new developments seeking to continuously improve the Irish health system and the growing costs arising from pensions and the state claims agency.

2017 saw the commencement of the unwinding of the savings delivered under the Financial Emergency Measures in the Public Interest Act 2009, this combined with other national pay agreements since 2016 has had a significant impact on the funding required to address pay cost pressures annually.

Significant funding is also allocated towards maintaining existing levels of service, however dealing with a growing and ageing population, more acute health and social care requirements, increased demand for new and existing drugs and the rising costs of health technology, continues to pose a financial challenge in maintaining levels of services within the funding available.

Description

Increase in 2016

Increase in 2017

Increase in 2018

Increase in 2019

Increase in 2020

HSE

€m

€m

€m

€m

€m

Pay Cost Pressures

59

174

278

287

Will be set

ELS/Demographics

401

244

491

254

out in the HSE

New Developments

137

81

196

199

2020 NSP

State Claims and Pensions

139

154

96

107

HSE Total

736

653

1,061

847

998

DoH

(1)

(2)

58

55

56

Capital

32

40

59

229

112

Total Health Vote

767

691

1,178

1,131

1,166

The increases provided in the Department of Health are predominantly attributable to the National Treatment Purchase Fund, the Sláintecare Integration Fund and a 2019 anticipated shortfall in Appropriations in Aid.

State Claims Agency Data

Questions (409)

Michael McGrath

Question:

409. Deputy Michael McGrath asked the Minister for Health the amount paid in legal costs to each of the top ten named legal firms representing plaintiffs in medical negligence cases in 2018; the number of cases that payments relate to in tabular form; and if he will make a statement on the matter. [44813/19]

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Written answers (Question to Health)

The State Claims Agency (SCA) has a statutory remit to manage personal injury claims, including claims in respect of clinical negligence, on behalf of Delegated State Authorities (DSA’s) including the Health Service Executive.

I have been informed by the State Claims Agency that the information in the report provided at the following link has been extracted from the National Incident Management System. The report shows the top 10 named Legal firms representing plaintiff legal costs made in relation to Clinical Care claims in 2018 with highest paid totals.

Report - Legal Firms

State Claims Agency Data

Questions (410)

Michael McGrath

Question:

410. Deputy Michael McGrath asked the Minister for Health the number of claims ongoing by the State Claims Agency in relation to late diagnosis and missed diagnosis in relation to failings in the CervicalCheck screening programme; the number of cases settled; the amount paid out in claims to date; and the legal costs of the cases to date. [44814/19]

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Written answers (Question to Health)

The State Claims Agency (SCA) has a statutory remit to manage personal injury claims, including claims in respect of clinical negligence, on behalf of Delegated State Authorities (DSA’s), including the Health Service Executive.

On a point of clarity, while the Deputy's question does reference late diagnosis and missed diagnosis, it is important to note that a screening test is not a diagnostic test. Cervical screening aims to prevent cervical cancer through the early detection and treatment of pre-cancerous changes on the cervix. Earlier detection can often increase treatment options, as well as reduce the invasiveness of that treatment. It is estimated that regular cervical screening can prevent 75% (or 3 out of 4) of cervical cancer cases. Since 2008, 1,200 invasive cancers have been detected by CervicalCheck. More than 50,000 women with high grade abnormalities (CIN 2 & 3) have been diagnosed and treated, considerably reducing their risk of developing cervical cancer. CervicalCheck has been successful in reducing cervical cancer rates in Ireland - these dropped from around 14 per 100,000 in the period 2009-2011 to 10 per 100,000 in the period 2013-2015. Cervical screening will not prevent all cases of cervical cancer, and some women will still develop cervical cancer despite regular screening.

Also, to clarify the Deputy's reference to failings in the cervical cancer screening programme, it should be noted that the Report of the Scoping Inquiry into the CervicalCheck Screening Programme, conducted by Dr Gabriel Scally, is unequivocal in stating that the widespread non-disclosure of the results of historical screening audits was a substantial breach of trust for the women and families concerned. It caused significant distress and additional suffering to those affected. However, Dr Scally was clear in his Final Report, published September 2018, that the Inquiry was satisfied with the quality management processes in the labs contracted by CervicalCheck.

His report presented no evidence that either the rates of discordant smear reporting or the performance of the programme fell below what is expected in a cervical screening programme. He confirmed that he found no reason why the existing contracts for laboratory services should not continue until the new HPV regime is introduced.

The SCA has provided me with the information set out below in relation to the Deputy's question. This information is correct as at 30 October 2019.

Response from State Claims Agency:

The information contained within this report has been extracted from the National Incident Management System (NIMS) and is as at 30th October 2019.

1. Number of Claims on hand

There are currently 125 claims relating to allegations of misinterpretation by the National Screening Service under active management by the State Claims Agency.

2. Number of Claims Settled

To date the SCA has settled 8 of these claims.

3. Amount paid out in claims to date

Due to the low number of claims, this figure is not published as it could lead to the identification of an individual.

4. Legal costs of the cases

In respect of all associated National Screening Services cases, legal costs amounting to €1,498,426 have been paid. These legal costs include fees paid to mediation services, which is consistent with the SCA’s policy of using mediation wherever possible to resolve these claims in a non-adversarial manner. These legal fees also include matters not relating to the areas in which the State has already accepted liability. It is anticipated that much of the work carried out in respect of these initial cases, and by extension the fees incurred, will be applied in resolving future cases that have been notified to the SCA and that this work will not need to be repeated in managing these future cases.

State Claims Agency Data

Questions (411)

Michael McGrath

Question:

411. Deputy Michael McGrath asked the Minister for Health the amount paid out by the State Claims Agency in respect of medical negligence claims for the first nine months of 2019; and the amount the agency has paid out in legal costs in respect of the pay-outs. [44815/19]

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Written answers (Question to Health)

The State Claims Agency (SCA) has a statutory remit to manage personal injury claims, including claims in respect of clinical negligence, on behalf of Delegated State Authorities (DSA’s) including the Health Service Executive.

I have been informed by the State Claims Agency that the information in the report provided at the following link has been extracted from the National Incident Management System. The report shows the total amount paid on all Clinical Care cases from 01/01/2019 to 30/09/2019 and a breakdown setting out the amounts paid in respect of Damages, Expert Costs, Plaintiff Legal Costs, and Agency Legal Costs.

Report - Medical Negligence

National Children's Hospital

Questions (412)

Paul Murphy

Question:

412. Deputy Paul Murphy asked the Minister for Health the carbon emissions specifications of the designs of the new national children's hospital and the new national maternity hospital. [45314/19]

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Written answers (Question to Health)

The National Paediatric Hospital Development Board (NPHDB) has statutory responsibility for planning, designing, building and equipping the new children's hospital. I have referred your question to the NPHDB for direct reply. The National Maternity Hospital query will similarly be referred to HSE Estates for direct reply.

Health Strategies

Questions (413, 414, 415, 556, 557)

Anne Rabbitte

Question:

413. Deputy Anne Rabbitte asked the Minister for Health the timeframe for the commencement of the HSE genetics programme; and if he will make a statement on the matter. [45590/19]

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Anne Rabbitte

Question:

414. Deputy Anne Rabbitte asked the Minister for Health when the review on personalised medicine will be completed; the date on which this will be available to the Houses of the Oireachtas; and if he will make a statement on the matter. [45589/19]

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Anne Rabbitte

Question:

415. Deputy Anne Rabbitte asked the Minister for Health his plans to undertake a public consultation with stakeholders on the development of the genetic healthcare strategy; and if he will make a statement on the matter. [45587/19]

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Anne Rabbitte

Question:

556. Deputy Anne Rabbitte asked the Minister for Health his plans to provide training for HSE staff on genetic screening; and if he will make a statement on the matter. [44667/19]

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Anne Rabbitte

Question:

557. Deputy Anne Rabbitte asked the Minister for Health the estimated number of patients that will benefit from whole genome sequencing; the steps he will take to ensure the adequacy of trained professionals to provide such a service; and if he will make a statement on the matter. [44668/19]

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Written answers (Question to Health)

I propose to take Questions Nos. 413 to 415, inclusive, 556 and 557 together.

Genomic medicine refers to the use of DNA analysis for the purposes of identifying genetic susceptibility to disease, differentiated drug responses based on genetic profiles, and is likely to increasingly include the application of gene editing. The implementation of genomic medicine in routine clinical care – often referred to as ‘personalised’, ‘precision’ or ‘stratified’ medicine – requires careful and comprehensive planning due to a range of scientific and social challenges. These include issues such as test reliability and validity, cost-effectiveness, health system and workforce readiness, and regulatory and ethical concerns. The application of genomic medicine is a relatively new and cutting-edge field; there are already some therapies in place, and considerable research being undertaken globally, to fully explore its potential applications.

Ireland is well placed for use of genomic medicine; with a relatively homogenous population, this provides opportunities to combine genetic information and health data. Ireland has a strong tradition of investing in genetic and genomic research through the Health Research Board, the Higher Education Authority and Science Foundation Ireland.

The 2014 Donnai and Newman Report commissioned by the HSE, recommended improvements in the governance, management and future development of genetic services. The 2016 Smith Report (Report of the National Genetic and Genomic Medicine Network Strategy Group) reviewed the Donnai and Newman Report and made recommendations for the next steps. On foot of these, in 2018 Acute Operations received new service development funding to begin the process of establishing a National Genetics and Genomics Medicine Network (NGGMN); to bring together all parties within the field of genomic medicine for multi-disciplinary working in a national clinical and research centre. The NGGMN will build the effective governance arrangements that recognises the interdependence between corporate, financial and clinical governance across the service and integrate them to deliver high quality, safe and reliable healthcare. Development of this NGGMN will be a joint initiative between Acute Operations and the Office of the Chief Clinical Officer and the recruitment process for a clinical lead is at an advanced stage.

As genomics is a new area of medicine, it is not possible to calculate how many patients might benefit, however it is likely that the specialisms of cancer, and rare diseases will be the among the first fields to benefit from advancements in genomics medicine. However, the demand for genetic assessment and testing is growing rapidly, due primarily to an increased awareness among the public and among health care professionals.

Many rare diseases are genetic in origin and, as such, effective genetic services can have an important role to play in relation to diagnosis and possible treatment. The medical genetics service in Our Lady’s Children’s Hospital, Crumlin provides services for patients and families affected by, or at risk of, a genetic disorder. It comprises three integrated units: a clinical genetics service; a cytogenetics laboratory and a molecular genetics laboratory. Our Lady’s Children’s Hospital, Crumlin, provided additional resources last year to support the hospital’s Department of Clinical Genetics. Investments in staff and equipment to further develop the service is continuing.

The National Cancer Strategy 2017-2026 highlighted the growing role of cancer genetics in cancer prevention and cancer care. The HSE's National Cancer Control Programme is working closely with clinical genetics and cancer genetics services in Our Lady’s Children’s Hospital, Crumlin and St James’s Hospital to develop the services to meet the growing need. Under the strategy, investments have been made in genetic counsellor, consultant and support positions, as well as cancer genetic testing.

I am aware of the significant opportunities and benefits afforded by genetic and genomic research, and in this regard, there are currently discussions underway with my officials. A key objective is to ensure that Ireland develops a comprehensive national policy/strategy, in consultation with stakeholders, which ensures that we both respond to these opportunities and overcome the not insignificant challenges of implementing a genomic medicine programme in a health service delivery context.

Regarding the provision of training for genetic services, as this is a service matter and I have asked the HSE to consider and respond directly to the Deputy.

Hospital Waiting Lists

Questions (416)

Mary Butler

Question:

416. Deputy Mary Butler asked the Minister for Health when a person (details supplied) will be called for a heart bypass operation; and if he will make a statement on the matter. [44187/19]

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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.

General Practitioner Services

Questions (417)

Peadar Tóibín

Question:

417. Deputy Peadar Tóibín asked the Minister for Health his plans to ensure that the north east doctor on-call is not removed from Navan, County Meath even on a temporary basis in view of the fact there are a number of alternative sites within the town that could house the unit. [44188/19]

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Written answers (Question to Health)

As this question relates to a service matter, I have arranged for it to be referred to the Health Service Executive for direct reply to the Deputy.

Hospital Beds Data

Questions (418)

Brendan Griffin

Question:

418. Deputy Brendan Griffin asked the Minister for Health the position regarding the opening of additional beds at Kenmare Community Hospital; the timeframe for the process leading to and including the opening of the beds; the planned staffing measures; the number of beds to be opened; and if he will make a statement on the matter. [44190/19]

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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.

Hospital Waiting Lists

Questions (419)

Denis Naughten

Question:

419. Deputy Denis Naughten asked the Minister for Health when a person (details supplied) will be called for a surgical procedure; the reason for the delay in same; and if he will make a statement on the matter. [44197/19]

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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 Beds Data

Questions (420, 427, 429)

Brendan Griffin

Question:

420. Deputy Brendan Griffin asked the Minister for Health the position regarding the opening of additional beds at a facility (details supplied); and if he will make a statement on the matter. [44198/19]

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Brendan Griffin

Question:

427. Deputy Brendan Griffin asked the Minister for Health if additional staff will be recruited at a community hospital (details supplied) in County Kerry to cover annual leave and short and long-term sick leave; and if he will make a statement on the matter. [44217/19]

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Brendan Griffin

Question:

429. Deputy Brendan Griffin asked the Minister for Health the reason bed capacity at a community hospital (details supplied) in County Kerry has reduced from 43 to 39; if additional resources will be deployed immediately to return bed capacity to 43; and if he will make a statement on the matter. [44220/19]

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Written answers (Question to Health)

I propose to take Questions Nos. 420, 427 and 429 together.

As these are service matters I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.

Health Strategies

Questions (421)

Stephen Donnelly

Question:

421. Deputy Stephen Donnelly asked the Minister for Health the progress made in establishing a health and social care advisory unit to provide him with the expert advice and support amid planned changes in public health services, including Sláintecare. [44199/19]

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Written answers (Question to Health)

This matter is under active consideration, in terms of the Department's overall priorities and staffing needs across all of its functions.

Hospital Appointments Status

Questions (422)

Pearse Doherty

Question:

422. Deputy Pearse Doherty asked the Minister for Health if an outpatient appointment provided to a person (details supplied) in County Donegal at Letterkenny University Hospital will be expedited; and if he will make a statement on the matter. [44200/19]

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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 Access

Questions (423)

Marcella Corcoran Kennedy

Question:

423. Deputy Marcella Corcoran Kennedy asked the Minister for Health the reason women in their 50s that are in perimenopause would be refused an x-ray; the reason the 10 day rule would apply in such cases; and if he will make a statement on the matter. [44208/19]

View answer

Written answers (Question to Health)

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

Medicinal Products Reimbursement

Questions (424, 606)

John Curran

Question:

424. Deputy John Curran asked the Minister for Health his plans to reimburse the drug opvido for the treatment of stage 3 melanoma cancer (details supplied); the process and associated timelines for same; and if he will make a statement on the matter. [44209/19]

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Kevin O'Keeffe

Question:

606. Deputy Kevin O'Keeffe asked the Minister for Health if he will enable the provision of a specific medication to patients diagnosed with stage 3 melanoma cancer (details supplied) [44904/19]

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Written answers (Question to Health)

I propose to take Questions Nos. 424 and 606 together.

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.

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, the company must submit an application to the HSE 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 or the Health Products Regulatory Authority.

As outlined in the Framework Agreement on the Supply and Pricing of Medicines, and in line with the 2013 Act, the HSE will decide, within 180 days of receiving the application (or a longer period if further information is sought from the company), to either add the medicine to the reimbursement list or agree to reimburse it as a hospital medicine, or refuse to reimburse the medicine.

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).

I am advised by the HSE that it has received a number of applications for the reimbursement of Nivolumab (Opdivo). Some of these have already been approved for reimbursement, including applications for the following indications:

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

- In combination with ipilimumab, indicated for the treatment of advanced (unresectable or metastatic) melanoma in adults

The HSE has received an application for the reimbursement of Nivolumab as monotherapy for the adjuvant treatment of adults with melanoma with involvement of lymph nodes or metastatic disease who have undergone complete resection.

In respect of this indication, a health technology assessment was completed on 13 October 2019 with the NCPE recommending that Nivolumab be considered for reimbursement if cost-effectiveness can be improved relative to existing treatments. The HSE will assess this application for reimbursement in line with the 2013 Health Act.

In March 2019, the VHI sent a circular to Oncologists advising them that it was extending cover to a number of new cancer medicines. The decision by the VHI applies only to private care to private VHI patients in private hospitals. It has no impact on the availability and use of medicines in public hospitals, where there is no distinction between public and private patients.

The effect of the VHI decision is that VHI private patients in private hospitals may have access to a medicine that is not yet available in the public hospital system. However, a number of the medicines, or indications, which the VHI has now decided to cover, are at various stages of the HSE assessment and reimbursement process with a view to making them available in the public hospital system.

Psychological Assessments Waiting Times

Questions (425)

Maurice Quinlivan

Question:

425. Deputy Maurice Quinlivan asked the Minister for Health the number of persons waiting to see a child psychologist in County Limerick by the number of months waiting. [44211/19]

View answer

Written answers (Question to Health)

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.

Health Services Staff

Question No. 427 answered with Question No. 420.

Questions (426)

Brendan Griffin

Question:

426. Deputy Brendan Griffin asked the Minister for Health if the embargo on the recruitment of healthcare assistants at a community hospital (details supplied) in County Kerry will be lifted to fill vacant posts and allow the return of staff on career breaks; and if he will make a statement on the matter. [44216/19]

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Written answers (Question to Health)

I am advised by the HSE that while there is no national recruitment embargo or moratorium, there is a priority requirement for all HSE services to maintain, or get to, an affordable staffing level that is sustainable in 2019 and 2020, while also prioritising the delivery of safe services.

In light of this, the HSE have introduced control measures relating to staffing and recruitment (including the return of employees on career breaks) to ensure that they live within the available resources provided to them.

In relation to the specific location of West Kerry Community Hospital, I have asked the HSE to respond directly to the Deputy.

Question No. 427 answered with Question No. 420.