Written Answers Nos. 1635-1661
1635. Deputy David Cullinane asked the Minister for Health the expenditure in 2021 for HSE-employed nurses advanced practice in terms of further education and training; the cost and extent of training courses covered by the HSE; the number of nurses to which this applied; and the cost of leave cover to facilitate training days. [29869/22]
View answerAs the Deputy may be aware, in November 2021 I requested that the number of nurses and midwives practising at an advanced level (AN/MPs) across the health service be increased from 2% of the workforce to 3% over the two/ three years. A target of 2% had been recommended in A Policy on the Development of Graduate to Advanced Nursing and Midwifery Practice. I have allocated funding of €11.9m to the HSE in 2022 for new AN/MP posts.
As the expenditure in 2021 on HSE-employed nurses advanced practice is a HSE service matter, I have asked the HSE to respond to the Deputy directly.
1636. Deputy David Cullinane asked the Minister for Health the estimated cost of doubling the staff subsidy component of the general medical services contract. [29870/22]
View answerUnder the GMS scheme, GPs are paid a subsidy towards the cost of employing a practice nurse and/or a practice secretary. Payments are made to participating GPs with a panel size of at least 100 GMS patients on a pro rata basis, with the maximum payment made to panels of 1,200 or more patients. Group practices may also qualify for a subsidy to employ a practice manager.
As the specific issue raised is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
1637. Deputy David Cullinane asked the Minister for Health the estimated cost of increasing medical intern places by 10% and the number of places that this would create; the additional staffing requirements to facilitate such an expansion and the estimated cost of same. [29871/22]
View answerIn relation to the particular query raised, as this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
1638. Deputy David Cullinane asked the Minister for Health the estimated cost of increasing basic specialist training places by 10% and the number of places that this would create; the additional staffing requirements to facilitate such an expansion and the estimated cost of same. [29872/22]
View answerIn relation to the particular query raised, as this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
1639. Deputy David Cullinane asked the Minister for Health the estimated cost of increasing higher specialist training places by 10% and the number of places that this would create; the additional staffing requirements to facilitate such an expansion and the estimated cost of same. [29873/22]
View answerIn relation to the particular query raised, as this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
1640. Deputy David Cullinane asked the Minister for Health the estimated cost of increasing general practitioner trainee places by 10%; the number of places that this would create and the estimated cost of same. [29874/22]
View answerThe HSE takes several factors into consideration when making its annual assessment of the number and type of specialist training places required within each specialty including but not limited to, future medical workforce planning projections, the number currently in training and the training capacity within the health system.
The number of GPs entering training has increased steadily over the past number of years, rising from 120 in 2009 to 233 in 2021. 258 places will be available in 2022. The transfer of GP training from the HSE to the Irish College of General Practitioners (ICGP) which was concluded in 2021 will allow for the introduction of a new service model for GP training in Ireland and the further expansion GP training capacity in the years ahead. The ICGP aims to have 350 training places available for new entrants per year by 2026. Until then, the annual increases in training places will be determined on an annual basis by the training capacity of the health system.
The annual year one cost of a doctor on the GP Training Scheme is approximately €100,000. With 258 places planned for the July 2022-23 training year, a 10% increase in training places would create an additional 26 places.
Based on these figures, the cost of a 10% increase in trainee intake for 2022-23 would be approximately €2.6 million.
1641. Deputy David Cullinane asked the Minister for Health the estimated cost of increasing training places for advanced practice nurses, nurse prescribers and clinical nurse specialists by 10%; and the number of places that this would create. [29875/22]
View answerAs the Deputy may be aware, in November 2021 I requested that the number of nurses and midwives practising at an advanced level (AN/MPs) across the health service be increased from 2% of the workforce to 3% over the two/ three years. A target of 2% had been recommended in A Policy on the Development of Graduate to Advanced Nursing and Midwifery Practice. I have allocated funding of €11.9m to the HSE in 2022 for new AN/MP posts.
As the estimated cost of increasing training places for advanced practice nurses, nurse prescribers and clinical nurse specialists by 10% and the number of places that this would create is a HSE service matter, I have asked the HSE to respond to the Deputy directly.
1642. Deputy David Cullinane asked the Minister for Health the estimated cost of providing public IVF services. [29876/22]
View answerAs the Deputy will be aware, a commitment to “introduce a publicly funded model of care for fertility treatment” is included in the Programme for Government. The model of care for infertility was developed by the Department of Health in conjunction with the HSE’s National Women & Infants Health Programme (NWIHP) in order to ensure that infertility issues are addressed through the public health system at the lowest level of clinical intervention necessary. This model of care comprises three stages, starting in primary care (i.e. GPs) and extending into secondary care (i.e. Regional Fertility Hubs) and then, where necessary, tertiary care (i.e. IVF, and other advanced assisted human reproduction (AHR) treatments), with patients being referred onwards through structured pathways.
Phase One of the roll-out of the model of care has involved the establishment, at secondary care level, of Regional Fertility Hubs within maternity networks, in order to facilitate the management of a significant proportion of patients presenting with infertility issues at this level of intervention. The completion of Phase One of the roll-out, envisaged before the end of this year, will result in fully operational Regional Fertility Hubs in each of the six Hospital Groups across the country.
Phase Two of the roll-out of the model of care will see the introduction of tertiary infertility services, including IVF, in the public health system. Substantial planning, development and policy work is required to establish the scope, design and requirements for this component of the model of care. At this juncture, the design and scope of this aspect of the model of care have not been finalised as detailed consideration of a range of issues including service and treatment design, eligibility and access criteria, and associated resource implications is required. This work will also need to be informed by the final Health (Assisted Human Reproduction) Act, the progress of this Bill – which passed Second Stage in the Dáil in March 2022 – and associated regulations that will be developed following the enactment of this legislation. My officials are continuing engagement with the HSE in relation to the necessary programmes of work required to further advance consideration of the issues arising for commencing Phase Two of the roll-out of the model of care.
1643. Deputy David Cullinane asked the Minister for Health the estimated cost for training and additional salary costs to increase the percentage of advanced nurse practitioners in the HSE workforce by 1%; and the estimated cost to increase same to 5%. [29877/22]
View answerAs this is a service matter, I have asked the Health Service Executive to respond directly to the Deputy, as soon as possible.
1644. Deputy David Cullinane asked the Minister for Health the estimated cost of restoring dental screening and treatment in schools. [29878/22]
View answerThe HSE Dental Service provides dental treatment services to eligible children in targeted groups, people with special care needs and others in the care of the HSE. Since the emergence of Covid-19, there has been a significant increase in delays accessing routine treatment for those in target school classes. This has resulted in backlogs emerging in the targeted schools programme.
In 2019 a total of 151,393 new oral health patients in target groups attended for scheduled assessment. The corresponding figure for 2020 was 55,324, in 2021 it was 82,494. The HSE is continuing to restore dental screening and treatment to children up to 16 years of age through recruitment initiatives to fill vacancies that have arisen or may arise; prioritizing clinical treatment and patient groups; and reallocating clinical resources to areas of greatest need.
The national approach to future oral health service provision will be informed by Smile agus Sláinte, the National Oral Health Policy (2019). A new model of service for children will be introduced in accordance with the evidence and WHO recommendations. Oral healthcare packages, which will include prevention, primary care and emergency care, will be the basis of service provision for children. These oral healthcare packages will be provided in a general dental care practice. Based on costings done by the ESRI, this is expected to cost in the region of €30 million.
1645. Deputy David Cullinane asked the Minister for Health the estimated cost of expanding newborn screening to the European Union average. [29879/22]
View answerThe expansion of the National Newborn Bloodspot (NBS) Programme is a priority for me, and the National Screening Advisory Committee (NSAC) has been progressing work on this expansion.
The NSAC is an independent, expert committee which makes recommendations to me and my Department on new screening programmes, as well as changes to existing population-based screening programmes.
The evidence bar for commencing a screening programme should and must remain high. This evidence threshold ensures that we can be confident that the programme in question is effective, quality assured and operating to safe standards for the population. The case for commencing or expanding a population-based screening programme is evaluated against internationally accepted criteria, and includes an examination of ethical, economic, legal and societal factors as well as the scientific evidence.
Financial cost is but one factor that is considered in the decision-making process. Due to the complex nature of the evaluation process and the criteria against which a decision is made, it would be impossible to accurately quantify the cost of expanding a screening service until a full evidential assessment was completed.
I am pleased to report recent progress in expanding newborn screening with a ninth condition, ADA-SCID (Adenosine Deaminase Deficiency Severe Combined Immunodeficiency), being added to the NBS programme on 23 May 2022. This important development means that all newborn babies in Ireland will now be screened, as part of the ‘heel prick’ test, for this rare condition which can be fatal if not diagnosed and treated early. Funding for this expansion was provided to the HSE in the budget.
The NSAC has also commissioned HIQA to undertake a Health Technology Assessment (HTA) looking at the addition of other SCID types to the NBS programme. This HTA is currently underway and includes an examination of budget impact and resource implications. I look forward to receiving a recommendation from the NSAC on this condition after the HTA process is finalised later this year.
1646. Deputy David Cullinane asked the Minister for Health the estimated cost of developing a structured care programme for general practice. [29880/22]
View answerThe Deputy will be aware of the GP Chronic Disease Management (CDM) programme which commenced in 2020 and which involves the ongoing monitoring of patients’ conditions. Under the programme, patients with one or more of the specified chronic conditions receive two scheduled reviews with their GP and practice nurse in a 12-month period. These reviews include patient education, preventative care, medication review, physical examination, investigations, and an individual care plan. The CDM programme also includes case finding and an annual preventive visit for patients identified with high risk of cardiovascular disease or diabetes. It is expected that over 430,000 people will benefit under this programme when it is fully rolled out in 2023 at an estimated annual cost of €80 million.
The cost of the provision of additional structured programmes would depend on a range of issues, such as the number of patients involved, the nature of the programme (the number of visits required, GP/nurse time involved, etc.) and would be subject to agreement on the respective fees to be paid to general practitioners.
1647. Deputy David Cullinane asked the Minister for Health the estimated cost of developing a structured care programme for general practice in women's health. [29881/22]
View answerExploring the potential for a structured life-course approach in primary care for all ages is a priority set out in the Women’s Health Action Plan. As a starting point, we will look at this idea through the lens of mid-life and older women. Action 7B of the Women's Health Action Plan has not yet commenced. Therefore, no cost benefit analysis of this measure is available from the Department at this time.
Funding was allocated through the Women's Health Fund in 2021 for a GP Clinical Lead in Women's Health. Dr. Ciara McCarthy is in post since March 2022. This post is funded for an initial 2-year period, at €97,379 per annum. The Clinical General Practice Lead in the areas of women’s health is carrying out a range of activities, including:
- Development of models of care, national guidelines, standard operating procedures (SOP), care pathways, decision support algorithms and performance metrics which can support integrated practice and comprehensive knowledge management and outcomes from new health pathways;
- Identification of the key areas for immediate and medium-term projects and address same through appropriate governance; and
- Liaison with colleagues in the Research Hub for General Practice to advocate for prioritisation and analysis of data relating to women's health programmes illustrating the impact of continuity of care for women and girls in primary care.
1648. Deputy David Cullinane asked the Minister for Health if there will be additional budgetary implications in 2023 to implement pay restoration for workers in section 39 organisations. [29882/22]
View answerUnder Section 39 of the Health Act 2004, the HSE provides financial assistance to organisations to provide services similar or supplementary to a service that the HSE may provide. However, Section 39 organisations are privately owned and run, and staff in these organisations are not public servants. Their terms and conditions of employment, once in line with employment legislation, are strictly between the employer and the employee.
Staff in these section 39 organisations were not subject to the provisions of FEMPI legislation and therefore did not receive those cuts that were applied to the pay of public servants. They were not and are not party to the Public Service Agreements and are therefore not covered by the pay restoration provided for in these Agreements. While it is understood that pay savings were made by the organisations, the precise mix of pay cuts or other savings measures will have varied.
In October 2018, an agreement was reached by the parties at the Workplace Relations Commission in relation to a process of pay restoration for staff employed in a pilot group of 50 section 39 organisations who are funded by way of a Service Level Agreement (SLA). Pay restoration commenced in April 2019 with an annual pay increase of up to €1,000. Any outstanding balance was paid in 2020 and 2021.
A further WRC engagement followed in December 2020 in relation to a final phase of 250 SLA funded organisations who were identified as part of the earlier agreement. A payment arrangement consisting of three phases was agreed with the first two payments to be made in 2021. The third and final instalment of the Pay Restoration for the 250 eligible Section 39 organisations is due in 2023, at a projected cost of €4.75m.
Pay restoration was applicable to Section 39 organisations who met certain criteria, rather than types of individual workers that are employed in them. The list of section 39 organisations that was compiled, included only agencies that had service arrangements in place back in 2013 and that were still under service arrangements in 2019. Only organisations who received in excess of an agreed, specified amount from the HSE by way of the Service Level Agreement process were included. There is no scope to revisit the eligibility criteria for the process and the process has reached a final resolution.
1649. Deputy David Cullinane asked the Minister for Health the estimated cost of increasing funded trainee clinical psychologist places by 50; and the estimated salary cost of 50 additional trainees, including employers' PRSI. [29883/22]
View answerIn relation to the particular query raised, as this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
1650. Deputy David Cullinane asked the Minister for Health the estimated cost of a 10% expansion in stepdown beds; and the estimated number of units that this would generate. [29884/22]
View answerAs this is an operational matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
1651. Deputy David Cullinane asked the Minister for Health the estimated capital cost of providing stepdown beds equivalent to 10% of existing capacity; and the estimated number of units that this would generate. [29885/22]
View answerAs the Health Service Executive is responsible for the delivery of public healthcare infrastructure projects, I have asked the HSE to respond to the Deputy directly on this matter.
1652. Deputy David Cullinane asked the Minister for Health the estimated revenue and capital cost of 100 additional leased stepdown beds. [29886/22]
View answerAs this is an operational matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
1653. Deputy David Cullinane asked the Minister for Health the level of funding allocated to the development of alternative care pathways in 2020, 2021 and 2022, in tabular form; the amount spent; and if he will make a statement on the matter. [29887/22]
View answer1654. Deputy David Cullinane asked the Minister for Health the level of funding allocated to pathfinder and other National Ambulance Service reform programmes in 2020, 2021 and 2022, in tabular form; the amount spent; and if he will make a statement on the matter. [29888/22]
View answerI propose to take Questions Nos. 1653 and 1654 together.
As these are service matters I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
1655. Deputy David Cullinane asked the Minister for Health the estimated cost of retaining additional allocations for the dental treatment services scheme made in 2022. [29889/22]
View answerThe 2022 estimates process provided €56 million for community dental services, and an additional €10 million was allocated in Budget 2022. The total 2022 budget is €66 million.
The additional money from Budget 2022 was allocated to provide for expanded dental health care for adult medical card holders including the reintroduction of Scale and Polish.
I am committed to the long-term reform of dental services to align with the National Oral Health Policy, Smile agus Sláinte. As the Deputy will appreciate, while I cannot comment at this stage on the outcome of the Estimates process, any future allocations will need to be aligned with the reform of services.
1656. Deputy David Cullinane asked the Minister for Health the estimated cost of one national counselling service counsellor, including employers' PRSI. [29890/22]
View answerAs this is a service matter I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.
1657. Deputy David Cullinane asked the Minister for Health the estimated cost of one senior dental surgeon and senior administrator, including employers' PRSI. [29891/22]
View answerThe salary scale for a Senior Dental Surgeon ranges from €78,268 to €99,930. The salary scale for a Senior Administrative Dental Surgeon (including higher duties allowance) ranges from €82,182 to €104,926. Employers pay 11.05% Class A employers' PRSI on weekly earnings over €410.
1658. Deputy David Cullinane asked the Minister for Health the estimated cost of one principal dental surgeon principal, including employers' PRSI. [29892/22]
View answerThe salary scale for a Principal Dental Surgeon [including planning and evaluation duties allowance) ranges from €96,342 to €116,965. The salary scale for a Principal Dental Surgeon (including regional duties allowance) is €94,199 to €114,360. Employers pay 11.05% Class A employers' PRSI on weekly earnings over €410.
1659. Deputy David Cullinane asked the Minister for Health the estimated cost of one dental nurse, including employers' PRSI. [29893/22]
View answerThe salary scale for a Dental Nurse [formerly Dental Surgery Assistant (with qualifications)] ranges from €25,422 to €46,540. Employers pay 11.05% Class A employers' PRSI on weekly earnings over €410.
1660. Deputy David Cullinane asked the Minister for Health the estimated cost of one speech and language therapist, including employers' PRSI. [29895/22]
View answerAs this is a service matter, I have asked the Health Service Executive to respond directly to the Deputy, as soon as possible.
1661. Deputy David Cullinane asked the Minister for Health the estimated cost of one national director of mental health, including employers' PRSI. [29896/22]
View answerAs this is a service matter I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.
