Written Answers Nos. 503-527
503. Deputy Steven Matthews asked the Minister for Health the position regarding funding allocations for those pursuing doctorates in educational and child psychology at Mary Immaculate College and UCD; if his attention has been drawn to the inequity in funding when compared to similar doctorate courses (details supplied); and if he will make a statement on the matter. [18921/23]
View answerAs the Deputy is aware, €750,000 has been provided in Budget 2023 to support counselling psychology training places. This funding demonstrates the Government’s commitment to strengthen access to psychology training.
I am focussed on supporting counselling psychology students in an equitable way and that delivers value for money. The structure of this funding is currently being finalised by officials in the Department. The approach will be based on best practice and knowledge gained from other health and social care funded training models.
Further detailed discussions are now taking place between the Department and HSE to progress this. I hope to be in a position to announce the details shortly for academic year 2023-2024. The Deputy may wish to seek the views of the Minister for Education in terms of funding for educational psychology places.
504. Deputy Maurice Quinlivan asked the Minister for Health the status of the case of a person (details supplied) who following a referral, in April 2022, to the ENT section at University Hospital Limerick has yet to receive an appointment date; and if he will make a statement on the matter. [18926/23]
View answerUnder 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.
In 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.
505. Deputy Sorca Clarke asked the Minister for Health the current vacancies in Mullingar Regional Hospital per department and speciality; and the length of time each post has been vacant, in tabular form. [18938/23]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the deputy directly, as soon as possible.
506. Deputy Paul Donnelly asked the Minister for Health the estimated full-year cost of recruiting two additional WTE senior dietitians in eating disorders for CHI Connolly. [18947/23]
View answerAs this is a service matter I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
507. Deputy Paul Donnelly asked the Minister for Health the number of WTE midwives working in each of the maternity hospitals within Dublin in 2020, 2021, 2022 and to date in 2023, in tabular form; if this number will be further increased; and if so, when. [18948/23]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
508. Deputy Paul Donnelly asked the Minister for Health how the additional €1.75 million will be spent on the meals-on-wheels service during 2023. [18949/23]
View answerAs this is an operational matter, I have asked the Health Service Executive to respond to the deputy directly, as soon as possible.
509. Deputy Marian Harkin asked the Minister for Health if the scheme for paid leave for public health service employees unfit for work post-Covid infection will be continued past the proposed finish date of 30 June, especially given the number of these staff still suffering ongoing effects of long-Covid; and if he will make a statement on the matter. [18970/23]
View answerI am keenly aware that the temporary Special Scheme of Paid Leave in respect of long-Covid is due to conclude at the end of June, and Officials in my Department are currently reviewing options in this regard. At present, those who remain unwell beyond that date may utilise the provisions of the Public Service Sick Leave Scheme.
510. Deputy Brendan Griffin asked the Minister for Health when a retired nurse’s pension arrears will issue to a person (details supplied) in County Kerry; and if he will make a statement on the matter. [18972/23]
View answerAs this is an administrative matter for the Health Service Executive, the HSE has been asked to respond directly to the Deputy.
511. Deputy Bernard J. Durkan asked the Minister for Health if financial assistance can be given to a person (details supplied); and if he will make a statement on the matter. [18978/23]
View answerThe Health Service Executive (HSE), on behalf of the State, administer several schemes which protect people from excessive medical costs.
The Long-Term Illness (LTI) Scheme was established under Section 59(3) of the Health Act 1970 (as amended). Regulations were made in 1971, 1973 and 1975, prescribing 16 illnesses covered by the Scheme. These are: acute leukaemia; mental handicap; cerebral palsy; mental illness (in a person under 16); cystic fibrosis; multiple sclerosis; diabetes insipidus; muscular dystrophies; diabetes mellitus; parkinsonism; epilepsy; phenylketonuria; haemophilia; spina bifida; hydrocephalus; and conditions arising from the use of Thalidomide.
Under the LTI Scheme, patients receive drugs, medicines, and medical and surgical appliances directly related to the treatment of their illness, free of charge. The LTI Scheme is not means tested and information on how to apply can be found here: www2.hse.ie/services/schemes-allowances/lti/.
People who cannot, without undue hardship, arrange for the provision of medical services for themselves and their dependants may be eligible for a medical card. In accordance with the provisions of the Health Act 1970 (as amended), eligibility for a medical card is determined by the HSE. Medical card eligibility is primarily based on an assessment of financial means and is not granted on the basis of any particular condition.
In certain circumstances, the HSE may exercise discretion and grant a medical card, even though an applicant exceeds the income guidelines, where he or she faces difficult financial circumstances, such as extra costs arising from illness. The HSE afford applicants the opportunity to furnish supporting documentation to determine whether undue hardship exists and to fully take account of all relevant circumstances that may benefit them in assessment, including medical evidence of costs and certain expenses.
In circumstances where an applicant is still over the income limit for a medical card, they are then assessed for a GP visit card, which entitles the applicant to GP visits without charge.
The Drug Payment Scheme (DPS) ensures that no individual or family pays more than €80 a month towards the cost of approved prescribed medicines. The DPS is not means tested and is available to anyone ordinarily resident in Ireland. It significantly reduces the cost burden for families and individuals not eligible for a medical card but with ongoing expenditure on medicines.
Further information regarding these, and other, schemes can be found at: www2.hse.ie/services/schemes-allowances/.
Individuals may also be entitled to claim tax relief on the cost of their medical expenses, including medicines prescribed by a doctor, dentist, or consultant. Relief is at the standard tax rate of 20%.
512. Deputy Michael Healy-Rae asked the Minister for Health the status of a hospital appointment for a person (details supplied); and if he will make a statement on the matter. [18985/23]
View answerUnder 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.
In 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.
513. Deputy Fergus O'Dowd asked the Minister for Health if he is aware of the drug seroquel being given to nursing home residents in cases in which the resident suffers from dementia; if there are known contraindications for such administration; and if he will make a statement on the matter. [18991/23]
View answerResidents in nursing homes receive medication as prescribed by a general practitioner or physician and as dispensed by a pharmacist. Prescribing practices including the choice of drug is the prerogative of the medical profession and not subject to review by inspectors of social service. Inspectors will review care records and medication administration records to ensure that residents receive their medication in line with the above prescriptions and any advice by the dispensing pharmacist.
In line with a recommendation from the National Dementia Strategy, my Department and the HSE's National Dementia Office have developed a national clinical guideline on the appropriate prescribing of psychotropic medication for non-cognitive symptoms in people with dementia. The Guideline, which was published in December 2019, provides evidence-based recommendations on the indications and risks of psychotropic medications for a person with dementia who has non-cognitive symptoms, such as anxiety or agitation.
With regard to protocols for giving sedatives, as this is an operational matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
514. Deputy Catherine Murphy asked the Minister for Health if he will set out the plans that the National Ambulance Service and hospitals have in the context of catastrophic incidents at lithium ion battery energy storage system failures. [18995/23]
View answerAs the Deputy may be aware, under the Fire Services Acts of 1981 and 2003 the country's Fire Services are the primary state response service to any chemical or hazardous spill, including any accompanying or subsequent explosion and/or fire event.
I have asked the Health Service Executive (HSE) to respond to the Deputy directly with any further pertinent information it may have on any related plans or protocols that it may have in place in respect of our acute hospitals and ambulance services.
515. Deputy Ged Nash asked the Minister for Health when a reply will be provided in relation to a representation sent to the HSE regarding a person (details supplied) in Meath; and if he will make a statement on the matter. [18997/23]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
516. Deputy Gino Kenny asked the Minister for Health if he will outline for the past ten years each time the income threshold to qualify for a medical card got updated or altered; and if he will respond with details of each or any update to qualify for a medical card. [18999/23]
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 and is specific to the individual’s own financial circumstances. In circumstances where an applicant is still over the income limit for a medical card, they are then assessed for a GP visit card, which entitles the applicant to GP visits without charge.
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.
With effect from April 2013, the gross income thresholds for people aged 70 and over were amended to €600 for a single person and to €1,200 a week for couples. From January 2014, the Health (Alteration of Criteria for Eligibility) (No. 2) Act 2013 amended gross weekly medical card income thresholds for those aged 70 or older to €500 per week for a single applicant and €900 per week for a couple. With effect from November 2020, the Health (General Practitioner Service and Alteration of Criteria for Eligibility) Act 2020 increased gross weekly medical card income thresholds for those aged 70 or older to €550 per week for a single applicant and €1,050 per week for a couple.
In circumstances where an applicant may be over the income limit for a medical card, Government approved the introduction of GP visit cards to enable eligible people make GP visits without charge. The Health (General Practitioner Service) Act 2014 introduced automatic eligibility for GP visit cards for those under 6 years of age. The Health (General Practitioner Service) Act 2015 introduced automatic eligibility for GP visit cards for those aged 70 or older. Under this legislation, access to a GP service is provided to all persons over the age of 70 on a universal basis. On 1 April 2019, GP visit card weekly income thresholds were increased by 10% as part of measures announced in Budget 2019.
I can assure the Deputy that, in order to ensure the medical card system is responsive and sensitive to people's needs, my Department keeps medical card issues, including the current medical card income thresholds, under review and any proposals are considered in the context of any potential broader implications for Government policy, the annual budgetary estimates process and legislative requirements arising.
517. Deputy Gino Kenny asked the Minister for Health if he plans to update the income threshold for a medical card to align with the current cost of living. [19000/23]
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. Examples of allowable expenses include rent, mortgage, certain insurance costs, childcare, maintenance, nursing home net costs which help to increase the amount a person can earn and still qualify for a medical card. Detailed guidelines are available at: Assessment for a medical card - HSE.ie.
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. However, it should be noted that those aged over 70 can also be assessed under the general means tested scheme where there are particularly high costs, e.g., medication, nursing home fees. Furthermore, the Deputy may be aware that, since 2015, every individual aged 70 and over has automatic eligibility for a GP visit card.
I can assure the Deputy that, in order to ensure the medical card system is responsive and sensitive to people's needs, my Department keeps medical card issues, including the current medical card income thresholds, under review and any proposals are considered in the context of any potential broader implications for Government policy, the annual budgetary estimates process and legislative requirements arising.
518. Deputy Gino Kenny asked the Minister for Health if he plans to update the qualification criteria for a medical card to consider long-term illnesses that have a cost burden on a household; and if he will make the qualification for a medical card to be more flexible to take in cost factors that are not on the current list. [19001/23]
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.
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.
519. Deputy Gino Kenny asked the Minister for Health if he plans to expand the medical card to all cancer patients under treatment. [19002/23]
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 to develop a legislative framework to underpin this administrative scheme. Medical cards awarded on end of life grounds are never re-assessed by the HSE thereby providing reassurance and comfort to patients and their families.
Separately, I can advise the Deputy that, since 2015, medical cards are awarded without the need of a financial assessment to all children under 18 years of age with a diagnosis of cancer. Further information can be found on the HSE’s website at www2.hse.ie/services/schemes-allowances/medical-cards/other-types-of-medical-card/emergency-medical-cards/.
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.
520. Deputy Pearse Doherty asked the Minister for Health if the drug melatonin is available under the discretionary hardship scheme for a person (details supplied) in County Donegal; and if he will make a statement on the matter. [19005/23]
View answerThe Health Service Executive (HSE) has statutory responsibility for medicine pricing and reimbursement decisions, in accordance with the Health (Pricing and Supply of Medical Goods) Act 2013.
In line with the 2013 Act and the national framework agreed with industry, a company must submit an application to the HSE to have a 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.
In making a relevant reimbursement decision, the HSE is required under the Act to have regard to a number of criteria including efficacy, the health needs of the public, cost effectiveness and potential or actual budget impact. 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).
The HSE advise that Melatonin (Circadin®), which is indicated for the short-term treatment of primary insomnia, has never been available under the Community Drug Schemes. Melatonin (Circadin®) underwent a review in 2008 and reimbursement was not recommended by the NCPE (see www.ncpe.ie/drugs/melatonin-circadin/).
However, the HSE advise that an application for Melatonin (Circadin®) can be made on an exceptional basis under Discretionary Hardship Arrangements for medical card holders. This is in accordance with Section 23 of the 2013 Act, which provides for the supply of items not on the Reimbursement List.
All applications under these arrangements are reviewed on an individual patient basis. The HSE must be satisfied that the patient requires the item for clinical reasons, and that there is no item on the reimbursement list which is a suitable alternative for that patient.
521. Deputy Paul Donnelly asked the Minister for Health when a review will be completed into the reimbursement process for cariban, the first-line treatment for hyperemesis gravidarum; and if he will make a statement on the matter. [19006/23]
View answer559. Deputy Catherine Connolly asked the Minister for Health the status of the review by the HSE of the current arrangement around the provision of cariban under the community drug schemes, and in particular the requirement that the initial prescriber be a consultant obstetrician; the terms of reference of the review; the timeline for the completion of the review; his plans to publish the recommendations of the review; if he will provide details of any representative groups being consulted as part of the review; and if he will make a statement on the matter. [19173/23]
View answer561. Deputy Marian Harkin asked the Minister for Health if he will provide an update and timeline for the commencement and completion of the review on the reimbursement process for cariban for the first-line treatment for hyperemesis gravidarum, which was announced in early February 2023; and if he will make a statement on the matter. [19202/23]
View answerI propose to take Questions Nos. 521, 559 and 561 together.
Dedicated funding of €1.3m was provided in Budget 2023 to provide reimbursement support for Cariban® (doxylamine/pyridoxine), for women suffering hyperemesis gravidarum, a severe form of nausea during pregnancy.
The Health Service Executive (HSE) has statutory responsibility for medicine reimbursement decisions under the community drugs schemes, in accordance with the Health (Pricing and Supply of Medical Goods) Act 2013.
Cariban® is not licensed in Ireland. It is classed as an Exempt Medicinal Product and cannot be added to the formal reimbursement list.
There are three other products containing doxylamine/pyridoxine which are licensed in Ireland. These are Xonvea®, Exeltis® and Navalem®. However, the respective market authorisation holders have not progressed with a pricing and reimbursement application to the HSE under the 2013 Act.
Following a review of the available evidence, the HSE considered the potential for a time-limited, quantity-dependent reimbursement arrangement for women with hyperemesis gravidarum, to access Cariban®, when prescribed by a consultant obstetrician and in line with clear clinical criteria, as set out by the HSE.
The HSE, therefore, put in place an exceptional arrangement which requires that the initial prescriber of Cariban® must be a consultant. The HSE will thereafter accept GP prescriptions for approved patients.
Prior to finalising this exceptional arrangement, the HSE engaged with the National Women and Infants Health Programme and the Programme was in agreement that the burden of the application process was tolerable and that the peer clinical community would welcome any opportunity to progress this matter for women in their care.
Cariban® has been available under this arrangement since the beginning of the year. As of 24 April 2023, 1,074 women have been approved for the product.
However, on the recognition that women suffering hyperemesis gravidarum may need access to Cariban® before their first consultation with their specialist/obstetrician, and in light of the fact that GPs prescribe Cariban® to private patients without an initial prescription from a specialist, I asked the HSE to review the current arrangement and report back to me.
The HSE have confirmed that the review it has undertaken will involve an analysis of current arrangements and of the access to Cariban® provided to patients since January 2023. The review will also include engagement with clinical leads, the HSE Primary Care Reimbursement Service and relevant advocates. To enable meaningful analysis, the HSE advise that several months of data will be required to complete the review.
In the meantime, the HSE encourages clinicians, along with the Institute of Obstetricians and Gynaecologists and the National Programme for Obstetrics and Gynaecology, other healthcare professionals, and relevant representative bodies to encourage the market authorisation holders of the licensed medicinal products (Xonvea®, Exeltis® and Navalem®) to progress with the formal pricing and reimbursement process in Ireland.
522. Deputy Pádraig O'Sullivan asked the Minister for Health if he will give a commitment that a service (details supplied) in County Cork will be continued; if he will confirm that there will be no disruption to night-time services; and if he will make a statement on the matter. [19014/23]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
523. Deputy Michael Creed asked the Minister for Health the current situation regarding replacement of GP services at a location in County Cork (details supplied). [19017/23]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
524. Deputy Pearse Doherty asked the Minister for Health if consideration has been given to allow a person (details supplied) use the National Purchase Treatment Fund to access urgent surgery; if each and every possible option available has been explored; and if he will make a statement on the matter. [19022/23]
View answerThe National Treatment Purchase Fund (NTPF) works with public hospitals, as opposed to with patients directly, to offer and provide the funding for treatment to clinically suitable long waiting patients who are on an inpatient/day case waiting list for surgery, having been referred on to such a list following clinical assessment by a consultant/specialist at an outpatient clinic.
The key criteria of the NTPF is the prioritisation of the longest waiting patients first. While the NTPF identifies patients eligible for NTPF treatment, it is solely on the basis of their time spent on the Inpatient/Daycase Waiting List.
The clinical suitability of the patient to avail of NTPF funded treatment is determined by the public hospital, who will also advise if a patient has complex clinical needs in order that appropriate arrangements can be made to fit the patient profile to the appropriately skilled provider. The availability of capacity for the specific procedure required by the patient is also a factor in the selection of treatment provider.
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.
In 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 Jim O'Callaghan asked the Minister for Health if he will provide an update on radiotherapy services across the country; the number of linear accelerators currently closed; what facilities these are located in; the impact of these closures on cancer treatment services; the number of radiotherapist vacancies nationally; and if he will make a statement on the matter. [19027/23]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the deputy directly, as soon as possible.
526. Deputy Éamon Ó Cuív asked the Minister for Health how many people received a medical card in each of the years 2020, 2021 and 2022; and the cost of this scheme to the State in each of these years; and if he will make a statement on the matter. [19035/23]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the deputy directly, as soon as possible.
527. Deputy Éamon Ó Cuív asked the Minister for Health the percentage of endoscopy capacity the BowelScreen programme has access to on a yearly basis; if this capacity varies per year; and if he will make a statement on the matter. [19037/23]
View answerAs this is a service matter, it has been referred to the Health Service Executive for attention and direct reply to the Deputy.
