Written Answers Nos. 509-528
509. Deputy David Cullinane asked the Minister for Health the number of persons who received a diagnostic test deemed as non-urgent at a symptomatic breast disease clinic in each of the years 2010 to 2021; and the percentage of these patients who received a diagnosis of cancer following their diagnostic test in tabular form. [44496/22]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the deputy directly, as soon as possible.
510. Deputy David Cullinane asked the Minister for Health the number of persons who received a diagnostic test at a lung rapid access clinic in each of the years 2010 to 2021; and the percentage of these patients who received a diagnosis of cancer following their diagnostic test in tabular form. [44497/22]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the deputy directly, as soon as possible.
511. Deputy David Cullinane asked the Minister for Health the number of persons who received a diagnostic test at a prostate rapid access clinic in each of the years 2010 to 2021; and the percentage of these patients who received a diagnosis of cancer following their diagnostic test in tabular form. [44498/22]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the deputy directly, as soon as possible.
512. Deputy David Cullinane asked the Minister for Health if there are plans to provide funding in budget 2023 to fund the provision of the FreeStyle Libre flash glucose monitoring system to persons with diabetes over 21 years of age based on clinical need; and if he will make a statement on the matter. [44499/22]
View answerThe Health Service Executive (HSE) has statutory responsibility for decisions on pricing and reimbursement of medical devices in the community drug schemes, in accordance with the Health (Pricing and Supply of Medical Goods) Act 2013. In making a relevant reimbursement decision, the HSE is required under the 2013 Act to have regard to a number of criteria including clinical efficacy, the health needs of the public, cost effectiveness and potential or actual budget impact. HSE decisions on which medicines and medical items are reimbursed by the taxpayer are made on objective, scientific and economic grounds, on the advice of the National Centre for Pharmacoeconomics (NCPE).
Currently, Consultant Endocrinologists may apply to the HSE, on behalf of specific patients with Type 1 Diabetes, for reimbursement support of FreeStyle Libre Flash Glucose Monitoring (FGM) sensors. The application process is undertaken by means of a dedicated online portal, which has been operational since 3 April 2018. In line with the recommendations of the Health Technology Assessment Group, access to this product was made available to children and young adults, aged between 4 and 21 years of age. The online application process does cater for the Consultant to make an application in very exceptional circumstances for a type 1 diabetic patient who is over 21 years of age.
The HSE requested that the NCPE carry out a full Health Technology Assessment (HTA) on Freestyle Libre, and the company, Abbott, were formally notified of this on 13 April 2021. Abbott had a scoping meeting with the NCPE in July 2021 and committed to submitting their HTA dossier by the end of October 2021. However, on 15 November 2021, Abbott informed the HSE that they would not be submitting the HTA dossier because they did not have the level of Randomized Controlled Trials (RCT) evidence that they stated was required for a full HTA process. Despite the HSE emphasising the importance of engaging with the HTA process to progress matters, the company have not submitted a HTA dossier to date. It remains open to Abbott to re-engage with the NCPE as they indicated they would in July 2021.
Recently, following a request from the HSE, the Health Information and Quality Authority (HIQA) held an initial meeting with the HSE Diabetes Clinical Programme to scope out what might be involved in undertaking a system wide HTA across diabetes care. In the absence of a full value assessment of the product to determine cost effectiveness or value for money, the HSE is not in a position to remove the current age restriction.
During the estimates process, deliberations as to the priorities to be progressed within the National Service Plan occur. It is not possible to say at this juncture whether additional funding of the FreeStyle Libre Flash Glucose Monitoring system will be provided.
513. Deputy David Cullinane asked the Minister for Health if he will ring-fence some of the anticipated 2021 cost savings from the recent HSE medicines management programme, MMP, preferred blood glucose strips for adults with type 1 and type 2 diabetes evaluation to fund the provision of the Freestyle Libre flash glucose monitoring system to persons with diabetes over 21 years of age based on clinical need; and if he will make a statement on the matter. [44500/22]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the deputy directly, as soon as possible.
514. Deputy David Cullinane asked the Minister for Health the number of applications for FreeStyle Libre that were submitted by individual hospitals for persons with diabetes over 21 years of age; the number that were approved; the number that were refused in each of the years 2017 to 2021, in tabular form; if there are plans to remove the age restriction on FreeStyle Libre; and if he will make a statement on the matter. [44501/22]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the deputy directly, as soon as possible.
515. Deputy David Cullinane asked the Minister for Health the number of children on initial and further waiting lists in County Tipperary by speciality in tabular form; the number of children by wait length; the number of children that are waiting for the first contact; and if he will make a statement on the matter. [44502/22]
View answerIt is recognised that waiting times for scheduled appointments and procedures have been affected by the Covid-19 pandemic. While significant work continues to positively impact on waiting times and improve pathways to elective care, acute hospitals are still impacted by operational challenges arising from the pandemic.
The HSE has confirmed to the Department that patient safety remains at the centre of all hospital activity and elective care scheduling. To ensure services are provided in a safe, clinically-aligned and prioritised way, hospitals are following HSE clinical guidelines and protocols.
The Department of Health continues to work with the HSE and the National Treatment Purchase Fund (NTPF) to identify ways to improve access to care, including through increased use of private hospitals, funding weekend and evening work in public hospitals, funding “see and treat” services, providing virtual clinics, and increasing capacity in the public hospital system.
The 2022 Waiting List Action Plan allocates €350 million to the HSE and NTPF to reduce waiting lists. Under this plan the Department, HSE, and NTPF will deliver urgent additional capacity for the treatment of patients, as well as investing in longer term reforms to bring sustained reductions in waiting lists.
This is the first stage of an ambitious multi-annual waiting list programme, which is currently under development in the Department of Health. Between them, these plans will work to support short, medium, and long term initiatives to reduce waiting times and provide the activity needed in years to come.
In relation to the particular query raised by the Deputy, the National Treatment Purchase Fund (NTPF) has provided the attached table which outlines the number of children from County Tipperary waiting for a first Outpatient appointment with a consultant in an Acute hospital, broken down by specialty and time band.
The NTPF only collects data on patients currently on the waiting list for a first outpatient appointment and does not collect data on patients waiting for review appointments.
516. Deputy David Cullinane asked the Minister for Health the availability of sexually transmitted infection testing kits in each CHO; and if he will make a statement on the matter. [44504/22]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the deputy directly, as soon as possible.
517. Deputy David Cullinane asked the Minister for Health the number of sexually transmitted infection clinics by CHO nationally; the staffing numbers and vacancy numbers at each; the length of time that the vacancies have existed; the active recruitment campaigns, if any, for the vacancies in tabular form; and if he will make a statement on the matter. [44505/22]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the deputy directly, as soon as possible.
518. Deputy David Cullinane asked the Minister for Health his plans to introduce a sexually transmitted infection clinic in Waterford; the availability of STI testing kits in Waterford; his plans to expand STI screening service in Waterford; the steps that his Department is taking to fund and resource this service; and if he will make a statement on the matter. [44506/22]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the deputy directly, as soon as possible.
519. Deputy David Cullinane asked the Minister for Health if he will reconsider the inclusion of the drug Praluent for reimbursement in the drug payment scheme; if he will provide an update on same; and if he will make a statement on the matter. [44507/22]
View answerThe HSE has statutory responsibility for decisions on pricing and reimbursement of medicines under the community drugs schemes, in accordance with the Health (Pricing and Supply of Medical Goods) Act 2013.
HSE decisions on which medicines are reimbursed by the taxpayer are made on objective, scientific and economic grounds. On occasion, the HSE, in stretching constrained resources, will make a decision to establish a Managed Access Protocol to identify those who would benefit most when making a decision to support reimbursement on a patient specific basis.
Alirocumab (Praluent) was added to the Reimbursement List with conditions on the 1st April 2021.
Reimbursement of PCSK9 inhibitors, alirocumab (Praluent) and evolocumab (Repatha) is supported under the High Tech Arrangement via a Managed Access Protocol overseen by the HSE-Medicines Management Programme.
Under the Managed Access Protocol for PCSK9 Inhibitors, reimbursement is supported for the following subgroups of the licensed population:
1. adults with a confirmed diagnosis of myocardial infarction +/- revascularisation procedures, non-haemorrhagic stroke or peripheral arterial disease (i.e. secondary prevention), or who have undergone coronary artery bypass graft, with a LDL-C persistently 3.5 mmol/L
2. adults with a confirmed diagnosis of heterozygous familial hypercholesterolaemia (HeFH) with a LDL-C persistently 4 mmol/L.
Both (1) and (2) would be despite optimum use of lipid-lowering therapy (atorvastatin/rosuvastatin + ezetimibe) or in the setting of confirmed intolerance to lipid-lowering therapy.
The Managed Access Protocol, which outlines in detail the criteria that must be satisfied in order for a patient to be approved for reimbursement of a PCSK9 inhibitor under the High Tech Arrangement, is available on the website of the HSE-Medicines Management Programme: hse.ie/eng/about/who/cspd/ncps/medicines-management/managed-access-protocols/pcsk9-inhibitors/.
520. Deputy David Cullinane asked the Minister for Health if will provide an update on the day care services in north Sligo, Cliffoney and Mougherow; when those services will resume to meet the demand in the area; the interim measures that are being considered by the HSE to provide off-site services; and if he will make a statement on the matter. [44508/22]
View answerAs this is an operational matter, I have asked the Health Service Executive to respond to the deputy directly, as soon as possible.
521. Deputy David Cullinane asked the Minister for Health when day care services will resume in west Sligo and at the day care centre in Easkey; if there are plans to resume a five-day service; and if he will make a statement on the matter. [44509/22]
View answerAs this is an operational matter, I have asked the Health Service Executive to respond to the deputy directly, as soon as possible.
522. Deputy Denis Naughten asked the Minister for Health the steps that he intends to take to provide financial support to small family-run nursing homes which are being forced out of business due to the failure by the National Treatment Purchase Fund to provide adequate funding to cover running costs, despite the fact that such homes have opened up their accounts to scrutiny; if he is satisfied that nursing home beds will now only be provided by large commercial operators; and if he will make a statement on the matter. [44520/22]
View answerI am acutely aware of the specific challenges faced by the nursing home sector related to price inflation and increased energy costs. I am currently working on proposals to support smaller and voluntary nursing homes in relation to the specific challenges they are experiencing and hope to make an announcement soon.
I engage consistently on an ongoing basis with Nursing Homes Ireland (NHI), the representative organisation for private and voluntary nursing homes. I have met directly with NHI and updated them in detail on progress being made in relation to this matter. I have also met with the National Treatment Purchase Fund (NTPF) to request that they consider the matter alongside departmental officials. I have visited a number of nursing homes to discuss this issue with management of both public and private/voluntary nursing units. It is imperative that nursing homes manage potential cost pressures in line with their regulatory and contractual responsibilities, maintaining their quality of care so that residents’ lived experience and comfort is not affected. Funding to support people to access services in the sector continues to be provided in line with the long-established statutory mechanisms under the Nursing Homes Support Scheme Act 2009. This is the mechanism established by the Oireachtas to provide for the processes relating to funding under the NHSS and the negotiation of prices for services for private and voluntary providers with the designated State agency, the National Treatment Purchase Fund (NTPF). Maximum prices for individual nursing homes are agreed with the NTPF following negotiations and based on the NTPF’s cost criteria. These criteria include:
- Costs reasonably incurred by the nursing home
- Local market prices
- Historic prices
- Overall budgetary capacityThe NTPF carry out this role independently under the NHSS Act 2009 and there is no role for Ministers or the Department in these negotiations. The department continues to work with the NTPF to take forward the recommended actions that emerged from the NTPF pricing review, as well as taking forward the nine recommendations of the Value for Money Review on Nursing Home Costs published last December.I would also like to highlight the other supports provided to the private and voluntary nursing home sector over the course of the pandemic. As you are aware, the COVID-19 Temporary Assistance Payment Scheme, also known as TAPS, has been in place since the start of the pandemic. Over €143 million has been made available to date under the scheme. The outbreak assistance element of the scheme is still in payment, having been extended up to September 2022. In addition to TAPS, direct support has been provided by the HSE to private nursing homes in many areas, including the provision of PPE, serial testing and support with staffing. In response to the strategic workforce challenges in the nursing home and home care sector, a Cross-Departmental Strategic Workforce Advisory Group has been established. The Group is working to a tight timeline and is committed to providing a set of recommendations by September 2022. Given the importance of nursing homes and the NHSS to the wider health and social care system - with a budget of over €1 billion, and over 22,000 residents supported - it is essential that policy measures are examined with due care in order to ensure the government's objectives are delivered and avoid unintended consequences. I hope to be in a position to update sector representatives as soon as possible.
523. Deputy Mary Lou McDonald asked the Minister for Health the number of children currently awaiting orthopaedic surgery at each of the Children’s Health Ireland hospitals in tabular form. [44525/22]
View answerIt is recognised that waiting times for scheduled appointments and procedures have been affected by the Covid-19 pandemic. While significant work continues to positively impact on waiting times and improve pathways to elective care, acute hospitals are still impacted by operational challenges arising from the pandemic.
The HSE has confirmed to the Department that patient safety remains at the centre of all hospital activity and elective care scheduling. To ensure services are provided in a safe, clinically-aligned and prioritised way, hospitals are following HSE clinical guidelines and protocols.
Improving access to paediatric orthopaedic services for children, including for children and young people with Spina Bifida, remains a commitment of Government. Paediatric orthopaedics is a priority area within the 2022 Waiting List Action Plan. €17.43 million has been provided this year to support additional activity to reduce waiting times for children waiting for orthopaedic procedures, including scoliosis and spina bifida, across CHI hospitals and Cappagh Orthopaedic Hospital.
Additional activity has been undertaken to date. By the end of August 2022, 342 scoliosis procedures had taken place across CHI Crumlin, CHI Temple Street, and Cappagh. This is in comparison to the same period in 2019 (pre-Covid) where 251 procedures had taken place. The Department of Health continues to monitor waiting lists for paediatric orthopaedic procedures and meets with the HSE weekly as part of the Waiting List Action Plan 2022 working group meetings.
In relation to the particular query raised by the Deputy, the National Treatment Purchase Fund (NTPF) has provided the attached table which outlines the number of children waiting for orthopaedic surgery in each of the Children’s Health Ireland hospitals by time-band at the end of August 2022.
524. Deputy Mary Lou McDonald asked the Minister for Health the number of children currently on the waiting list for spinal fusion surgery at Temple Street Children’s Hospital; and the length of time that each child has been on the waiting list in tabular form. [44526/22]
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.
525. Deputy Michael Healy-Rae asked the Minister for Health his views on whether a review should be carried out on the ceiling on income for qualifying for a medical card considering the rising cost-of-living at present; and if he will make a statement on the matter. [44527/22]
View answerEligibility for a Medical Card is primarily based on a financial assessment which is conducted by the HSE in accordance with the Health Act 1970 (as amended). The HSE assesses each medical card application on a qualifying financial threshold. This is the amount of money that an individual can earn a week and still qualify for a card. It is specific to the individual’s own financial circumstances.
Persons aged 69 and under are assessed under the general means tested medical card thresholds which are based on an applicant’s household income after tax and the deduction of PRSI and the Universal Social Charge. Certain expenses are also taken into account, i.e. mortgage payments, which help to increase the amount a person can earn and still qualify for a medical card.
Persons aged 70 or older are assessed under the over 70s medical card income thresholds which are based on gross income. It should be noted that in November 2020, the weekly gross medical card income thresholds for those aged 70 and over were increased to €550 per week for a single person and €1050 for a couple. This increase helps to ensure that a greater proportion of those aged 70 and over qualify for a medical card.
I wish to assure the Deputy that the current medical card income thresholds are kept under review and any changes that may be required are considered in the context of Government policy, the annual budgetary estimates process and other issues which may be relevant.
526. Deputy Mary Lou McDonald asked the Minister for Health the progress that has been made in completing 67 additional spinal fusion surgeries and 28 additional spinal procedures for children with scoliosis as well as an additional 141 procedures for children with spina bifida following his announcement earlier in 2022 of an additional €17.43 million of current and capital funding to increase orthopaedic activity at Children's Health Ireland. [44530/22]
View answerImproving access to paediatric orthopaedic services for children, including for children and young people with Spina Bifida, remains a commitment of Government. Paediatric orthopaedics is a priority area within the 2022 Waiting List Action Plan. €17.43 million has been provided this year to support additional activity to reduce waiting times for children waiting for orthopaedic procedures, including scoliosis and spina bifida, across CHI hospitals and Cappagh Orthopaedic Hospital.
In relation to activity year to date for the particular procedures requested, as this is an operational matter, I have asked the Health Service Executive to respond to the Deputy directly as soon as possible.
527. Deputy Chris Andrews asked the Minister for Health if his Department will provide assistance in a case in which student nurses have been refused the pandemic bonus payment by the hospital in which they completed their placement (details supplied). [44531/22]
View answerFirstly, I would like to extend my sincere gratitude to all healthcare workers for their efforts during this most challenging period.
On January 19th, the Government announced a COVID-19 pandemic recognition payment for frontline public sector healthcare workers, to recognise their unique role during the pandemic. The Government decision provides, subject at all times to the overarching eligibility criteria, that only eligible staff within the following cohorts are covered for this Pandemic Recognition Payment:
1. HSE and Section 38 organisations;
2. Private Sector Nursing Homes and Hospices (e.g. Private, Voluntary, Section 39 etc.);
3. Eligible staff working on-site in Section 39 long-term residential care facilities for people with disabilities;
4. Agency roles working in the HSE;
5. Health Care Support Assistants (also known as home help / home care / home support) contracted to the HSE;
6. Members of the Defence Forces redeployed to work in frontline Covid-19 exposed environments in the HSE;
7. Paramedic staff employed by Dublin Fire Brigade to deliver services on behalf of the HSE.
As such, any individual who is deemed eligible for payment a) must fit within one of the 7 cohorts highlighted above, and b) must also fit the criteria for payment, as have been set out in the eligibility guidelines and FAQs, as apply to the HSE and Section 38 agencies, which are available on the HSE website: www.hse.ie/eng/staff/resources/hr-circulars/hr-circular-012-2022-pandemic-special-recognition-payment.html
For clarity, those who fall outside of the above are not in scope for this payment. There are many, many other individuals in our country who did so much during the pandemic. The Government is sincerely grateful for this commitment, but it is appropriate that those eligible frontline healthcare workers get particular recognition. It was tough to draw a line on this matter, but the Government based its decision on the risks which eligible frontline healthcare workers faced.
I note that some private sector healthcare employers have already recognised their frontline workers for their extraordinary efforts since March 2020. The Government would encourage those other private sector healthcare employers who have not done so to adopt appropriate measures to recognise their frontline workers.
528. Deputy Mary Lou McDonald asked the Minister for Health if the additional current and capital funding for orthopaedic activity at Children’s Health Ireland which includes various sections (details supplied) has been used solely to increase orthopaedic activity at CHI; and if not, if the budgets have in part or in whole been reallocated or used to fund other areas of care in CHI. [44534/22]
View answerThe funding was provided to specifically target orthopaedic activity, including scoliosis and spina bifida. I have asked the Health Service Executive to respond to the Deputy directly as soon as possible, to confirm that this is the case.
