Written Answers Nos. 386-404
386. Deputy Catherine Murphy asked the Minister for Health if he and the HSE will reinstate full antenatal services at Naas General Hospital; if he will outline the rationale for scaling back the services; and if he will set out plans to establish a full-time antenatal service in Kildare; and if locations to hold them have been identified. [18794/23]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
387. Deputy Michael Ring asked the Minister for Health when student nurses will receive a payment (details supplied); and if he will make a statement on the matter. [18796/23]
View answerAs the Deputy may be aware, following approval by Government on 13th December 2022, I was pleased to announce €9 million in additional supports for student nurses and midwives, €5.4m of which has been allocated to the HSE to introduce an enhanced Travel and Subsistence Scheme for eligible students while attending their supernumerary clinical practice placements.
The Secretary General of my Department issued a letter of sanction to the HSE on February 15th confirming that Budget 2023 provides funding to cover the €5.4 million cost associated with the enhanced travel and subsistence scheme for 2023. It also confirmed sanction for expenditure of €2.4 million to cover arrears of travel and subsistence from September to December 2022. The letter of sanction to the HSE requested that payments that were due to eligible student nurses and midwives be prioritised.
My Department also issued Circular 4/2023 to the HSE on February 27th setting out revised arrangements to apply regarding accommodation allowance, the continuation of the travel allowance and the introduction of a subsistence allowance in the form of a €500 meals allowance. These revised arrangements are to take effect from the beginning of the academic year 2022/2023. Circular 4/2023 is attached for reference.
My Department continues to engage with the HSE in relation to the prompt implementation of the circular and payment of these allowances. As implementation of the enhanced travel and subsistence scheme is an operational matter for the HSE, I have asked the HSE to respond directly to the Deputy in this regard.
388. Deputy Steven Matthews asked the Minister for Health the position regarding the roll-out of GP cards to include people on or below the median income as committed to under Budget 2023; and if he will make a statement on the matter. [18799/23]
View answerThe Government is committed to the extension of GP visit card eligibility to those who earn the median household income or less, as announced in Budget 2023.
In total, approximately 400,000 additional individuals are estimated to become eligible under this expansion. This measure will remove the cost of accessing GP care from those for whom cost is most likely to prevent access, helping reduce the cost of living for young adults and young families in particular.
The necessary planning and administrative development work to provide for the expansion is well advanced in preparation for the commencement of the expansion. Officials from my Department and the HSE are currently engaged in intensive discussions with the IMO regarding the expansion and in particular the concerns of the IMO on the impact of increased eligibility on general practice and the best use of the additional funding provided in Budget 2023 to support capacity in general practice.
Information in relation to the commencement of the expansion and further operational information will be provided when available.
389. Deputy Brendan Griffin asked the Minister for Health why SSWHG has not met Kerry Oireachtas members for so long; and if he will make a statement on the matter. [18850/23]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the deputy directly, as soon as possible.
390. Deputy Brendan Griffin asked the Minister for Health why a cardiologist is not in place at UHK; and if he will make a statement on the matter. [18851/23]
View answerReferred to the HSE as a service matter.
391. Deputy Bernard J. Durkan asked the Minister for Health the extent to which he remains focused on enabling rehabilitation and methadone treatments for those who have been adversely affected by drugs; and if he will make a statement on the matter. [18853/23]
View answerThe national drug strategy, Reducing Harm Supporting Recovery, provides an integrated public health approach to drug and alcohol use, focused on reducing the harms for individuals, families and communities and promoting rehabilitation and recovery.
Opioid substitution treatment (OST) supports patients to recover from drug dependence. Methadone prescribing for opioid dependence remains a key element of the harm reduction approach to opioid use set out in the strategy, along with suboxone. Action 14 in the strategy seeks to increase access to and improve the availability of OST in community settings and homeless services.
HSE addiction services work within the national drugs rehabilitation framework to support progression pathways. The framework ensures that individuals affected by drug misuse are offered a range of integrated options tailored to meet their needs and to create rehabilitation pathways.
Over the last 3 years and in response to the COVID-19 Pandemic, the HSE introduced a number of innovative changes to the delivery of care for this cohort to enable them safely access treatment and significantly reduce waiting times.
These innovations included:
• Clinical Guidelines on the rapid induction of clients to treatment were developed and modified in response to the ongoing pandemic
• Amendments to the Misuse of Drugs regulations
• Availability of OST was widened extensively and additional homeless settings were able to engage people on OST to ensure appropriate care.
• In recognition of the difficulties some individuals may have in accessing care, virtual clinics for prescribing GPs were established.
• A particular emphasis was placed on the provision of buprenorphine/naloxone (suboxone) as a medication to be used in OST. This has resulted in a significant increase in the number of people receiving this medication and an increase in GPs prescribing the medication
As a result of these innovations and changes, the HSE Addiction services and community level 1 and level 2 GPs are now providing OST to almost 1000 more individuals than at the end of January 2020 as can be seen in the table below.
|
Jan 2020 |
October 2022 |
|
|
Methadone |
10,233 |
10,774 |
|
Buprenorphine/Naloxone |
262 |
706 |
|
Total |
10,495 |
11480 |
The number of GPs prescribing buprenorphine-based products has increased from 37 at the end of January 2020 to 61 now. This is in line with action 14.
Additional funding of €4.2 million was provided in 2021 for the continued treatment of an additional 1,000 clients on opioid substitution treatment (OST), who were given access to OST in 2020 and 2021 under the Covid-19 contingency plan for people who use drugs.
I am committed to improving the availability of this treatment and to developing services to meet the needs of people on opioid substitution treatment.
392. Deputy Bernard J. Durkan asked the Minister for Health the total number of rare and orphan drugs currently being evaluated for use in Ireland; the length of time that normally required for this process; the drugs that have taken an inordinate amount of time to evaluate and approve for use here; and if he will make a statement on the matter. [18854/23]
View answerUnder the Health (Pricing and Supply of Medical Goods) Act 2013, the HSE has statutory responsibility for the administration of the community drug schemes; therefore, the matter has been referred to the HSE for attention and direct reply to the Deputy.
393. Deputy Bernard J. Durkan asked the Minister for Health the action being taken to ensure the availability of an adequate number of health professionals within the health services, including, but not limited to, consultants, GPs and nurses to meet the demand in all areas throughout the country; and if he will make a statement on the matter. [18855/23]
View answerHealth and Social Care workforce planning and ensuring an appropriate pipeline of suitably qualified healthcare professionals in Ireland is a top priority for the Government.
My department is committed to ensuring that there is an adequate number of health professionals to meet demand within the health service. As part of this commitment, the department is heavily invested in the ongoing education of healthcare staff to support recruitment and retention. Data from Health in Ireland Key Trends 2022 (DOH 2022) shows that students graduating as both undergraduate and postgraduate in medicine, pharmacy and nursing and midwifery increased consistently between 2014 and 2020, with the total number of students graduating increasing by 30% (from 4,841 to 6,264).
Department of Health officials engage on an ongoing basis with colleagues in the Department of Further and Higher Education, Research, Innovation and Science and other relevant stakeholders to ensure that we train enough graduates with the skills necessary to support the delivery of health and social care services and to develop a strategic approach to workforce planning for the health sector.
There has been a significant growth in publicly funded doctors in training, non-training scheme doctors and consultants averaging 5.6% over the last five years. The Department have been working closely with the HSE, and Postgraduate Training Bodies to increase the number of training places and Consultant posts available within the health service in line with workforce planning projections. Recent increases include:
• The total number of interns increased by 12% over the last five years period, the IST (Initial Specialist Training) intake increased by 21% and the HST intake increased by 27%
• The number of doctors in training in Ireland now stands at 4,167 (excluding interns), an increase of 4.5% since 2021/22.
• The number of Year 1 Higher Specialist Training (HST) posts increased by 10%, from 573 in 2021/22 to 629 in 2022/23.
• The number of specialists exiting postgraduate training (including GPs) increased from 388 in 2021 to 452 for 2022.
• 33% expansion of GP training programme over the last six years. The number of GP training places is based on the commitment to reach an intake of 350 annually into the general training programme. There is a plan in place, agreed with the ICGP, to reach this number by 2026.
• The number of approved Consultant posts increased by 9% from 3,797 in 2021 to 4,152 in 2022.
In relation to the availability of GPs, the Government has undertaken several measures to improve the number of GPs working in the State and ensure patients continue to have access to GP services across the country. Under the 2019 GP Agreement additional annual expenditure provided for general practice has been increased now by €211.6m. This provides for significant increases in capitation fees for participating GMS GPs, and new fees and subsidies for additional services. Improvements to GP’s maternity and paternity leave arrangements and a support for GPs in disadvantaged urban areas, have also been provided for. In addition, the enhanced supports package for rural GP practices was increased by 10%.
There has been unprecedented growth in all staff categories in the Health Service over recent years. In February the total workforce stands at 139,186 WTE. This is an increase of 1,441 WTE from December figures. In 2020, 2021 and 2022 the HSE achieved the three largest increases in the workforce since the foundation of the HSE. This expansion is continuing in 2023 with an expected growth of 6,000 WTE. There are 19,369 more WTE working in our health service than there were at the beginning of 2020. This includes 6,201 nurses and midwives; 3,047 health and social care professionals; and 1,805 doctors and dentists. Work is ongoing to improve retention policies, speed up recruitment processes and to add more educational places to expand the workforce to the largest extent possible.
The HSE are targeting all nursing, midwifery and health and social care graduates across all Irish colleges with the offer of permanent positions in the HSE, together with competitive relocation packages to entice our graduates from previous years home.
The HSE is expanding its international reach with innovations such as the development of the Medical Consultant Hub which is promoted internationally and also developing attraction strategies specific to each grade category and the strategies will include promoting the full extent of career opportunities available within the HSE.
394. Deputy Bernard J. Durkan asked the Minister for Health if he is satisfied that the health services can be co-ordinated in such a way as to ensure a modern response to patients' needs in all areas throughout the country; and if he will make a statement on the matter. [18856/23]
View answerI can assure the Deputy that work is ongoing to integrate and co-ordinate our health and social care services, and to ensure that patients have rapid access to high-quality care in response to their needs throughout the country. With annual funding of €195 million allocated to the continued implementation of the Enhanced Community Care (ECC) Programme, for example, the process of integrating health care responses between acute and community settings - and of re-orienting the focus of service delivery towards primary and community care - is progressing. This means delivering more care closer to where patients live, in line with the objectives of Sláintecare. To date:
94 of the planned 96 Community Healthcare Networks (CHNs) are now established;
21 of 30 Community Specialist Teams (CSTs) for Older Persons are now established;
21 of 30 Community Specialist Teams for Chronic Disease Management are now established; and
21 Community Intervention Teams (CITs) are operational with national coverage secured, and these continue to be expanded.
The Community Healthcare Networks - for the first time in Ireland - provide for the integration of General Practice (GP) with wider community services. This provides the foundational structure for the delivery of integrated care, allowing for more local decision-making, and improving access to the primary care services that individuals, families, and carers need.
Alongside these, the Community Specialist Teams provide consultant-led multidisciplinary care to older persons, and those with chronic disease, in the community. This reflects the shift in focus away from the acute hospital and towards a primary and community-based service model in response to patient needs.
The Community Intervention Team service provides a rapid and integrated response to patients experiencing an acute episode of illness, and facilitates the delivery of enhanced care in the community or home setting. This prevents unnecessary hospital admission or attendance, and facilitates the discharge of patients to community care when clinically appropriate. We are currently providing for further expansion of CITs across the country, with a particular focus on the Mid-West and North-West regions.
Recruitment to the ECC Programme is continuing, with 2,356 WTEs having commenced their roles to date, while a further 244 WTE are at an advanced stage of recruitment, out of a total targeted recruitment of 3,500 staff.
Work also continues in the delivery of the GP direct referral pathway to diagnostics, so that patients can access these tests quickly and without seeing a consultant, and without having to attend hospital. This structured pathway for GPs to directly access diagnostic tests enables a greater level of care to be delivered in the community, supporting patient-centred care, early diagnosis, and early intervention.
Last year, over 250,000 diagnostic radiology scans including X-rays, CT scans, MRI scans and DEXA were provided nationally to patients referred directly by their GPs to contracted private providers, located in convenient settings within the community and closer to home.
We have ensured - through a funding allocation of €47 million to the initiative in Budget 2023 - that the full adult population is eligible to be referred for these outsourced radiology scans is maintained, and we are targeting delivery of over 240,000 radiology scans this year, with almost 90,000 scans already provided this year to date. Further to this, the initiative continues to be expanded to include provision of direct referral by GPs of their patients to Echocardiography, Spirometry and NT-proBNP blood tests in public laboratories and will target delivery of over 266,000 of these diagnostic tests this year.
In support of these ongoing reforms, the Government is also committed to the implementation of Regional Health Areas (RHAs), as outlined in the Programme for Government. RHA implementation involves the creation of six regional divisions in the HSE with responsibility for the planning and delivery of hospital, community and social care services within their respective areas. These new arrangements will improve the health service’s ability to deliver more joined-up care, integrated for patients that is planned and funded in line with regional and local needs.
While RHAs are not a panacea for all the challenges our system experiences, they are a necessary step towards providing rapid access to better, high-quality care for patients. RHAs will serve as an enabling platform for co-ordinating our acute, community, and primary care services and help to support a modern, equitable, and integrated response to patients' needs in all areas throughout the country.
395. Deputy Bernard J. Durkan asked the Minister for Health the reason for delay in dealing with the waiting lists of children seeking procedures for scoliosis; and if he will make a statement on the matter. [18857/23]
View answerI sincerely regret that children can experience a long waiting time for scoliosis treatment and remain conscious of the burden that this places on them and their families.
Last year I approved an ambitious plan from Children’s Health Ireland (CHI) to reduce the number of children waiting for spinal orthopaedic procedures (scoliosis/spina bifida) by the year end. Some €19 million of current and capital funding was committed to implement the plan.
This funding is providing additional theatre access at Temple Street and Crumlin, diagnostic MRI capacity and enabling further activity and paediatric theatre lists at Cappagh Hospital. The additional activity is targeted at reducing the number of children waiting long periods for orthopaedic procedures (including scoliosis and spina bifida). CHI and Cappagh Kids continue to work to explore new innovative ways of working and develop initiatives to support additional orthopaedic and scoliosis activity.
2022 saw a record number of scoliosis procedures carried out, 509 compared to 380 for the same period in 2019, a 34% increase and an increase of 47% compared to 2021. Despite the increase in the number of procedures, corresponding reductions in the waiting list were offset by significant increase in demand and referrals compared to previous years, with a 30% increase in additions to the spinal surgery list compared to 2021. CHI believes this is due to a loss of additional capacity elsewhere and latent Covid-19 demand via increased outpatient activity. The increased levels of activity have continued in 2023 with 125 procedures carried out to the end of March compared to 105 in the same period in 2022.
The 2023 Waiting List Action Plan was published on the 7th of March as the next stage of our new multi-annual approach to reducing and reforming hospital waiting lists and times. Funding of €363 million has been allocated to this Plan, which includes €123 million to be made available to the HSE on a recurring basis to progress longer-term reforms including to streamline and reconfigure care pathways and to sustainably enhance capacity – in particular for the priority areas of Paediatric Orthopaedics (Spina Bifida/Scoliosis), Gynaecology and Obesity/Bariatrics.
396. Deputy Bernard J. Durkan asked the Minister for Health when the promised phase of the Naas hospital development plan will be activated in accordance with the original projections; when the facility will be completed and opened; and if he will make a statement on the matter. [18858/23]
View answerAs the Health Service Executive is responsible for the delivery of public healthcare infrastructure projects, I have asked the HSE to respond to you directly in relation to this matter.
397. Deputy Bernard J. Durkan asked the Minister for Health the proposed best protection for vulnerable groups, including the elderly, within the public health sphere to ensure their protection to the best possible standard; and if he will make a statement on the matter. [18859/23]
View answerThe Health Service Executive (HSE) and the Health Protection Surveillance Centre (HPSC) regularly publish public health advice for older people and other service users on how to stay well and be protected, including publications on keeping well in winter and on vaccination, which are available online on HSE’s and HPSC's websites at the following web addresses:
• www2.hse.ie/living-well/winter/how-to-stay-well-in-winter/.
• www2.hse.ie/living-well/winter/advice-patients-with-chronic-conditions/.
• www2.hse.ie/conditions/flu/getting-the-vaccine/.
• www.hpsc.ie/publications/.
Protecting older or vulnerable patients and service users who may be at risk of abuse, harm, and neglect by others in the context of their interactions with the health and social care sector is a key objective of my Department, every statutory body under its aegis, and every relevant service that interacts with such adults. In the health and social care sector, a framework of standards, policies and procedures for safeguarding adults who may be at risk of abuse, harm, neglect, and exploitation within the sector is in place, and further measures are being developed to strengthen this framework. The existing framework includes:
• the application within the health sector of relevant cross-sectoral legislation, for example in relation to reporting certain offences against children or vulnerable persons to An Garda Síochána, vetting, equal status and assisted decision-making;
• the significant regulatory powers of HIQA and the Mental Health Commission in relation to the quality and safety of healthcare and social care provision generally (under the Health Act 2007 and the Mental Health Acts);
• joint national adult safeguarding standards developed by HIQA and the Mental Health Commission, approved by the Minister for Health.
• the roles of health and social care professional regulatory bodies in relation to, for example, professional registration requirements and professional codes of conduct.
• a range of operational structures and procedures, including in particular the HSE’s national operational adult safeguarding policy Safeguarding Vulnerable People at Risk of Abuse – Policy and Procedures (2014).
The Programme for Government commits to ‘Introduce a statutory scheme to support people to live in their own homes, which will provide equitable access to high-quality, regulated home care’. The Department continues to develop a regulatory framework for providers. This will comprise primary legislation for the licensing of providers, secondary legislation in the form of regulations, and HIQA national standards.
My Department remains committed to ensuring that the best possible safeguards are in place to protect any of our service users who may be at risk, and significant work is ongoing to develop health sector adult safeguarding policy and legislation, building on the robust structures already in place. Work is also ongoing on the drafting of legislation to enhance the oversight and regulation of nursing homes, which will include provision for a broader suite of enforcement tools for the Chief Inspector of Social Services.
398. Deputy Bernard J. Durkan asked the Minister for Health the extent to which efforts are being made to replace GPs where the incumbents have retired leaving vacancies throughout the country; the number of such vacancies; and if he will make a statement on the matter. [18860/23]
View answerGPs are self-employed practitioners and therefore may establish practices at a place of their own choosing. There is no prescribed ratio of GPs to patients and the State does not regulate the number of GPs that can set up in a town or community.
Under the GMS scheme, the HSE contracts GPs to provide medical services without charge to medical card and GP visit card holders. Currently there are 2,539 GPs contracted to provide services under the GMS Scheme.
Where a vacancy arises in a practice with a GMS contract, the HSE becomes actively involved in the recruitment process to find a replacement GP. While recruitment is ongoing, the HSE put a locum or other suitable arrangement in place to provide continuity of care for the area concerned. As of the start of the month, there are 34 GMS vacancies across the country, approximately 1 percent of the total number of GMS panels. It is acknowledged that certain vacancies can be difficult to fill, possibly due to location and/or the financial viability of smaller practices.
The Government has undertaken several measures to improve the number of GPs working in the State and ensure patients continue to have access to GP services across the country.
Under the 2019 GP Agreement additional annual expenditure provided for general practice has been increased now by €211.6m. This provides for significant increases in capitation fees for participating GMS GPs, and new fees and subsidies for additional services. Improvements to GP’s maternity and paternity leave arrangements and a support for GPs in disadvantaged urban areas, have also been provided for. In addition, the enhanced supports package for rural GP practices was increased by 10%.
The number of doctors entering GP training has increased approximately ten percent year on year from 2019, rising from 193 in 2019 to 258 in 2022, and a further large increase is planned for this year. Following the transfer of responsibility for GP training from the HSE to the Irish College of General Practitioners (ICGP), it is aimed to have 350 training places available for new entrants per year by 2026.
I recently published the Terms of Reference for a Strategic review of General Practice which is to commence shortly and will be completed this year. The review, with input from key stakeholders, will examine the broad range of issues affecting general practice including issues around GP capacity, and will set out the measures necessary to deliver a better general practice. The provision of GP services in certain rural and urban deprived areas that are underserved, and the possible mechanisms to attract more GPs to these locations, is a specific issue that will be examined under the review.
399. Deputy Bernard J. Durkan asked the Minister for Health the extent to which the various changes and requirements needed to fully introduce Sláintecare are being pursued at present; and if he will make a statement on the matter. [18861/23]
View answerThe Government is fully committed to the to the continued delivery of Sláintecare reform and to the Sláintecare vision of a universal health and social care system where everyone has equitable access to services based on their need, and not on their ability to pay. Investment of €23.4 billion in Budget 2023 in Ireland’s Health and Social Care Services is the highest allocation of funding to the health service in the history of the state. This will facilitate better access to affordable and equitable, high-quality healthcare for people at a time when the cost-of-living crisis is impacting on everyone.
The Sláintecare Progress Report for 2022 was published last month (gov.ie - Sláintecare Progress Report 2022 (www.gov.ie). It shows that the reform measures taken so far are making a positive impact on patient’s lives. It presents the work undertaken to deliver foundational long-term change that will significantly enhance overall capacity and will deliver patient-centred care. The report highlights significant achievements made in improving access, affordability and quality in our health and social care services. The 2023 Sláintecare Action Plan (accessible at this link: gov.ie - Sláintecare Action Plan 2023 (www.gov.ie) was also recently published. It will build on the very real progress made with the focus in 2023 continuing to be on improving access, outcomes, and affordability for patients by increasing the capacity and effectiveness of the workforce, infrastructure and delivery of patient care.
The Sláintecare Programme Board was established in 2021 to drive the reform programme and embed the Sláintecare principles throughout the health and social care service. The Board is co-chaired by the Secretary-General of the Department of Health (DoH) and Chief Executive Officer of the Health Service Executive (HSE) and provides senior official interagency strategic leadership, oversight, and accountability for delivery of the Sláintecare reform programme. Updates on the implementation of Sláintecare are also provided to the Cabinet Committee on Health, chaired by the Taoiseach, and to the Joint Oireachtas Committee on Health.
400. Deputy Bernard J. Durkan asked the Minister for Health the degree by which it is intended to reduce the numbers on hospital waiting lists by whatever means over the next twelve months; and if he will make a statement on the matter. [18862/23]
View answerThe Government recognises that acute hospital scheduled care waiting lists are far too long, and that many patients are waiting an unacceptably long time for care. However, progress is being made through our new multi-annual approach to reducing and reforming hospital waiting lists and times.
The 2023 Waiting List Action Plan which was published on the 7th of March is the next stage of this new multi-annual approach. Under the Plan, the Department of Health is funding the HSE and NTPF to deliver services to remove c. 1.66 million patients from waiting lists, resulting in a projected reduction of just over 10% by year-end to c.621,000 people.
This is building on the reductions in the waiting lists achieved in Q4 2021 (5%) and again in 2022 (4%) via previous waiting list action plans – 2022 was the first annual decrease in hospital waiting lists since 2015.
Funding of €363 million has been allocated to the 2023 Waiting List Action Plan which includes:
• €123 million to be made available to the HSE on a recurring basis to progress longer-term reforms including to streamline and reconfigure care pathways and to sustainably enhance capacity – in particular for the priority areas of Obesity/Bariatrics, Paediatric Orthopaedics (Spina Bifida/Scoliosis) and Gynaecology.
• €150 million allocated to the NTPF to procure additional capacity to reduce hospital waiting lists backlogs.
• €90 million to the HSE and NTPF to implement additional short-term measures to address acute scheduled care waiting list backlogs in 2023.
The NTPF’s 2022 initiative relating to offering treatment to clinically suitable patients waiting more than 6 months for 15 high volume procedures (including cataracts, hip, and knee replacements), has been extended in 2023 through reducing the time to 3 months and expanding to 20 high volume procedures.
To progress the implementation of long-term reforms in tandem with continuing to address waiting list backlogs, the 2023 Plan focuses on three key areas under which 30 short, medium, and long-term actions will be delivered this year to achieve the target reductions in waiting lists and waiting times. The three key areas are Delivery Capacity in 2023, Reforming Scheduled Care, and Enabling Scheduled Care Reform.
While there is much focus on the overall waiting list, the agreed longer-term objective is that people are seen within the agreed Sláintecare maximum wait times (10 weeks OPD, 12 weeks IPDC / GI Scope). As such, the key metric is not the total number of people waiting, but rather the total number of people waiting longer than these Sláintecare maximum wait times. In 2022, the number of people waiting over the Sláintecare targets fell by 11%, or 56,000 people. Since the pandemic peaks in 2020/21, there has been a 24% reduction in the number of people waiting longer than the Sláintecare targets. The 2023 Plan will continue this positive momentum by driving further significant waiting time improvements by the end of this year.
The Waiting List Task Force will continue to meet regularly to drive and oversee progress of the delivery of the 2023 Waiting List Action Plan throughout the year and provide regular updates to the Minister for Health and the Sláintecare Programme Board.
401. Deputy Bernard J. Durkan asked the Minister for Health the extent to which dental patients can have their requirements met and progressed as quickly as possible with particular reference to medical card holders; and if he will make a statement on the matter. [18863/23]
View answerThe Dental Treatment Services Scheme (DTSS) provides dental care, free of charge, to medical card holders aged 16 and over. Services available annually and on demand include an examination including preventative elements, two fillings, emergency extractions, and a scale and polish. More complex care, such as dentures, and a broader range of treatments for patients with additional needs and high-risk patients are available subject to the approval of the local HSE Principal Dental Surgeon. This approval is granted within 30 days of an application being received.
I am aware that there are some towns with no or limited DTSS dentists that have sufficient capacity to accept new patients. Where access to a dentist is difficult, local HSE services assist patients who make enquiries and make lists of DTSS contractors available to medical card holders. In exceptional circumstances, the HSE assists patients to access emergency dental treatment by directly contacting private contractors or arranging treatment to be provided by HSE-employed dentists.
An additional allocation of €15 million has been made in Budget 2023 to enhance the provision of oral healthcare services. This includes €5 million allocated on a once-off basis to support the HSE Public Dental Service to provide care this year, including through a HSE ‘safety-net’ service for adult medical card holders who are in need of emergency care and are still having difficulty accessing a local dentist.
402. Deputy Bernard J. Durkan asked the Minister for Health the extent to which eligibility for medical cards for those diagnosed with serious or life-threatening illness can be upgraded to take account of the individual circumstances of their case not based on financial eligibility but hardship grounds; and if he will make a statement on the matter. [18864/23]
View answerMedical Card provision is primarily based on financial assessment. In accordance with the Health Act 1970 (as amended), eligibility for a medical card is determined by the HSE, which assesses each application on a qualifying financial threshold.
The issue of granting medical or GP visit cards based on having a particular disease or illness was previously examined in 2014 by the HSE Expert Panel on Medical Need and Medical Card Eligibility. The Group concluded that it was not feasible, desirable, nor ethically justifiable to list medical conditions in priority order for medical card eligibility. In following the Expert Group’s advice, a person’s means remains the main qualifier for a medical card.
However, every effort is made by the HSE, within the framework of the legislation, to support applicants in applying for a medical card and, in particular, to take full account of the difficult circumstances in the case of applicants who may be in excess of the income guidelines. The HSE may exercise discretion and grant a medical card, even though an applicant exceeds the income threshold where they face difficult financial circumstances, such as extra costs arising from an illness. Social and medical issues are also considered when determining whether undue hardship exists for an individual accessing general practitioner or other medical services.
The HSE also has a compassionate system in place for the provision of medical cards where persons are in need of urgent ongoing medical care or when a patient is receiving end of life treatment – that is when patients’ unfortunately have a prognosis of less than 12 months.
In addition, since March 2021, persons who have been certified by their treating Consultant as having a prognosis of 24 months or less are now also awarded a medical card on an administrative basis. This measure delivered the Programme for Government commitment to extend eligibility for medical cards to persons with a terminal illness and work is continuing on developing a legislative framework to underpin this scheme.
I can assure the Deputy that, to ensure the medical card system is responsive and sensitive to people's needs, my Department keeps medical card issues under review and any changes are considered in the context of Government policy and other issues which may be relevant.
403. Deputy Bernard J. Durkan asked the Minister for Health the extent to which the provision of primary care centres throughout County Kildare is ongoing, with particular reference to the needs of Maynooth, a university town with a potential population of 40,000, Celbridge, with a growing population of up to 30,000, and Leixlip, with a growing population of up to 30,000; and if he will make a statement on the matter. [18865/23]
View answerAs the Health Service Executive (HSE) holds responsibility for the provision, along with the maintenance and operation of Primary Care Centres, I have asked the HSE to respond directly to the Deputy as soon as possible.
404. Deputy Bernard J. Durkan asked the Minister for Health the degree to which access to various medicines remains equally available to those in this jurisdiction, as compared with the rest of the single market in Europe, and at a similar price; and if he will make a statement on the matter. [18866/23]
View answerIn Ireland, the Health Service Executive (HSE) has statutory responsibility for decisions on pricing and reimbursement of medicines, in accordance with the Health (Pricing and Supply of Medical Goods) Act 2013. Reimbursement is for licensed indications which have been granted market authorisation by the European Medicines Agency or the Health Products Regulatory Authority. In line with the 2013 Act, and the national framework agreed with industry, a company must first submit an application to the HSE to have a new medicine added to the reimbursement list.
Two new Framework Agreements on Pricing and Supply of Medicines 2021-2025 were signed in December 2021. These Agreements provide stability to the medicines reimbursement market for the State and for Industry, thus facilitating sustainable and affordable access to medicines for patients in Ireland over the next 4 years.
Negotiations towards these new Agreements with industry began in May 2021, against a backdrop of a growing annual drugs budget, up from €1.95bn in 2016 to almost €2.25bn by 2020.
The multi-annual agreements with the Irish Pharmaceutical Healthcare Association (IPHA) and Medicines for Ireland (MFI) represent an important step in facilitating access to innovative new medicines for patients. The IPHA represent the originator and on-patent biopharmaceutical industry; MFI represent the non-originator, and off-patent biopharmaceutical industry in Ireland.
There are a number of clauses set out in both agreements in detail, which provide clear pricing rules for applicant companies, that have been agreed between the State and main Pharmaceutical Industry representative groups in Ireland as appropriate and intended to provide a predictable environment for Marketing Authorisation Holders (MAHs) to supply their products. These are grossly summarised as:
The pricing application form for new medicines is based on a basket of 14 countries (13 EU Member States and the UK). Pricing is permitted to be no more than the average price based on the pricing in these 14 countries.
The pricing of non-patented medicines (i.e., generic, biosimilar or hybrid medicine marketed in Ireland) is based on the originator medicine at a specific time point.
Under the terms of the agreement, there is scope for the Department of Health, the HSE, and industry to continue to maintain their engagement throughout the lifetime of the agreement on all matters pertaining to the agreement.
