Written Answers Nos. 364-384
364. Deputy Bernard J. Durkan asked the Minister for Health the extent to which plans are in hand to ensure an adequate GP service throughout County Kildare, given the number of GPs retiring and the existing and future demands; and if he will make a statement on the matter. [26989/23]
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 33 GMS vacancies across the country, approximately 1 percent of the total number of GMS panels. There is one GMS vacancy in County Kildare, in Maynooth.
While the HSE provides a contribution towards locum expenses for leave taking purposes to GPs under the GMS contract, as private practitioners, locum cover is arranged by the GP concerned as necessary. The relevant HSE Community Health Organisation will assist a GMS GP in providing locum cover where possible.
The Government is aware of the workforce issues currently facing general practice and is working to ensure patients across the country continue to have access to GP services and that general practice is sustainable in all areas into the future.
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.
These measures will make general practice in Ireland a more attractive career choice and will see an increase in the number of GPs working in the State, improving access to GP services for patients throughout the country.
Furthermore, I recently published the Terms of Reference for a Strategic review of General Practice which will be completed this year. The review, with input from key stakeholders, will examine the broad range of issues
365. Deputy Bernard J. Durkan asked the Minister for Health the extent to which it is intended to ensure the availability of full medical cards for those with life changing or terminal conditions, given the degree to which such families are under stress; and if he will make a statement on the matter. [26990/23]
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.
366. Deputy Bernard J. Durkan asked the Minister for Health the number of health professionals likely to be covered by the regulations of health professionals Bill; and if he will make a statement on the matter. [26991/23]
View answerAs the Deputy may be aware the Regulated Professions (Health and Social Care) (Amendment) Bill 2022 has now passed all Oireachtas stages. The Bill's key provisions relate to certain registration routes for social care workers and access for holders of UK medical degrees who wish to take up intern posts here.
Once the register for social care workers opens, the Health and Social Care Professionals Act 2005 will provide five routes to registration - section 38 which will be used by graduates of one of the 30 approved social care work programmes and section 91 which will be available until November 2025 for those who have worked in the profession for two years by that deadline and either:
(i) hold a qualification specified in Schedule 3 of the Act or
(ii) hold a professional qualification deemed to be sufficiently relevant and attesting to a standard of proficiency comparable to a specified Schedule 3 qualification or
(iii) complete an Assessment of Professional Competence or
(iv) have been determined by their employer to meet the standards of proficiency for the profession in accordance with guidelines issued by CORU.
CORU has advised that there are in the region of 8,000-10,000 qualified social care workers in Ireland though it is difficult to give an exact number because of the multiplicity of employment titles used by the profession. It is not possible to estimate the number of applicants likely to avail of the five individual pathways to registration.
In relation to holders of UK medical degrees applying for intern posts, this has historically been low but is expected to increase as more students are encouraged to take up places in Northern Ireland in particular.
367. Deputy Bernard J. Durkan asked the Minister for Health the current position in regard to the construction of the new maternity hospital; the degree to which the necessary preparations are being advanced; and if he will make a statement on the matter. [26992/23]
View answerThe Preliminary Business Case (PBC) and pre-tender Final Business Case (FBC) for the relocation of the National Maternity Hospital (NMH) were submitted to the Department of Health by the NMH Project Board for combined review at Decision Gates 1 and 2 of the 2019 Public Spending Code (PSC) lifecycle process. Under the March 2023 update to the PSC, this review most aligns with Stages 1 and 2 and as such is continuing through the current process of presentation to the Major Projects Advisory Group (MPAG) and seeking consent of Government to proceed.
The External Assurance Process (EAP) Review of the NMH business case documentation at Gates 1 and 2 of the PSC and the presentation to the MPAG has been completed. The findings of MPAG are currently being reviewed and subject to any amendments or updates recommended by the MPAG, it is expected that the business case can be brought to Government for information and consent to proceed to tender.
In the interim, the Project Board is pursuing opportunities to accelerate or parallel certain activities related to the project that can be undertaken without presupposing the outcome of the Government consent so that the tender process can be deployed as soon as possible after a positive Government decision.
368. Deputy Bernard J. Durkan asked the Minister for Health the current position in the construction of the new children's hospital; when completion is expected; and if he will make a statement on the matter. [26993/23]
View answerThe New Children’s Hospital (NCH) project comprises the main hospital on a shared campus at St James’s, and two Outpatient and Urgent Care Centres at Connolly and Tallaght hospitals. Both satellite centres are now open and successfully delivering a new model of ambulatory and urgent care for children and adolescents in the Greater Dublin Area.
Works are progressing well on the main site, with the construction and equipping phase now over 85% complete against contract value. The major focus in 2023 continues to be the internal fit-out and commissioning of mechanical and electrical services. The first of the 4,600 clinical rooms have been completed and the remaining rooms will follow in a planned sequence. The 380 individual inpatient rooms are taking shape with fit out of fixtures, ensuites, sliding doors and medical equipment progressing. The hospital will have 93-day beds, with plumbing and joinery now taking place in these areas. The large glass biome, that envelopes the panoramic lifts providing intuitive access to all areas of the building, is complete, as well as the rooflights and ward end glazing to the Level 4 Rainbow Garden. Landscaping and tree planting is underway in the outdoor areas. The elevated helipad space is progressing into the final stages of assembly, with helipad structure completed.
Government has been previously advised that the project and programme will take longer and therefore cost more. The last construction programme received from the main contractor, BAM, suggests substantial completion on the build could be achieved by March 2024. The National Paediatric Hospital Development Board (NPHDB) continues to engage with the contractor to secure an updated and compliant programme, as required under the construction contract, to get certainty on this substantial completion date and to focus on ensuring that everything possible is being done to complete the construction project as soon as possible. Following substantial completion the hospital will be handed over to Children’s Health Ireland (CHI) for a period of operational commissioning. Planning for the complex process of commissioning over 6,150 spaces to be ready to accommodate services for patients, post substantial completion, is well advanced.
There remain risks beyond the control of the NPHDB and the contractor to the timeline, arising from Brexit, the global pandemic, the invasion of Ukraine and its impact on supply chains, global supply chain difficulties more generally, including shortages of construction raw materials, and the current inflationary pressures on energy and material costs.
Whilst there is a focus on the capital project and its delivery, we must not lose sight of the fact that the NCH project will deliver world class facilities that will improve and prioritise medical outcomes for the nation’s sickest children, while bringing about transformational change to the delivery of healthcare for the children of Ireland for generations to come.
369. Deputy Bernard J. Durkan asked the Minister for Health the extent to which adequate staffing has or is being achieved at all levels throughout the health services, with a view to ensuring maximum operational levels; and if he will make a statement on the matter. [26994/23]
View answerOver the past three years, there has been a targeted commitment to ensure significant expansion of the health sector workforce. This is evident through the record breaking funding secured in order to build this vital additional capacity.
Since 2019, this record-breaking expansion has seen an additional 20 thousand whole-time equivalents added to the workforce. This is substantial growth of 17%.
In 2020, we achieved the largest expansion of the health service workforce since the foundation of the HSE with an additional 6,357 whole-time equivalents added.
There are 20,686 more WTE working in our health service than there were at the beginning of 2020. This includes 6,505 nurses and midwives; 3,212 health and social care professionals; and 2,031 doctors and dentists.
I have also referred this question to the Health Service Executive to address what is being done at an operational level to maximise operations.
370. Deputy Róisín Shortall asked the Minister for Health the status of the Health (Adult Safeguarding) Bill 2017; the rational for this Bill not being developed by his Department, given that adult safeguarding is much broader than the health sector; his views on a cross-departmental and inter-agency approach, as well as a whole of society approach; and if he will make a statement on the matter. [27019/23]
View answerI thank the Deputy for clarifying through her office that the question relates to the anticipated Health (Adult Safeguarding) Bill and the rationale for this Bill being developed by my Department.
I and my Department take the risk of abuse of vulnerable adults in healthcare and social care contexts very seriously. In the health and social care sector, various structures and processes, including legislative and policy measures, are available to protect against abuse and ensure prompt action.
To further strengthen the existing framework for the sector under my Department's remit, my Department is developing an overarching national policy on adult safeguarding in the health and social care sector. To facilitate the development of appropriate legislation to underpin this policy, subject to its approval by the Government, the Government has included a Health (Adult Safeguarding) Bill in its current Legislation Programme.
As the Deputy correctly notes, adult safeguarding is much broader than the health sector. It is an important matter for all sectors, society as a whole, all agencies and all Government Departments. While every sector has specific safeguarding responsibilities for adults at risk within their remit, currently no one Department has an assigned lead or coordinating cross-sectoral role.
Separately from my Department's policy development work specifically in relation to the health and social care sector, the Law Reform Commission is preparing a major report on A Regulatory Framework for Adult Safeguarding , that is expected to inform future policy and legislation on adult safeguarding across all sectors.
Upon completion of the Commission’s report, I expect that relevant Departments will consider any recommendations the Commission may make regarding legislation relevant to their Departments’ functions and any recommendations it may make in relation to cross-departmental, cross-sectoral, inter-agency or whole of society approaches.
371. Deputy Róisín Shortall asked the Minister for Health the services available to assist where persons are concerned with another person’s serious self-neglect which may be a danger to themselves or others and where the HSE safeguarding and protect teams confirm that they do not have a role in safeguarding if there is no third-party causing harm to the person in question (details supplied); who has responsibility for providing such a service; and if he will make a statement on the matter. [27022/23]
View answerAs these are operational matters, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
372. Deputy Róisín Shortall asked the Minister for Health the contact arrangements that are in place, outside of the hours 9.00am to 5.00pm Monday to Friday, for emergency safeguarding services (details supplied); and if he will make a statement on the matter. [27023/23]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the deputy directly as soon as possible.
373. Deputy Róisín Shortall asked the Minister for Health the status of a review (details supplied) which examined the governance arrangements around the HSEs drug pricing and reimbursement process; if the implementation group has been established; the timeline this group is working towards to progress the implementation of the recommendations; and if he will make a statement on the matter. [27026/23]
View answerIn February, I published the Mazars Review which examined the governance arrangements around the HSE’s Drug Pricing and Reimbursement Process. I fully support the recommendations contained in the Mazars report around improving the process, increasing transparency, providing easier access, and supporting value for money.
An implementation group has been established between my Department and the HSE to consider and progress the various recommendations contained in the Report. The Group has met on a number of occasions and is currently embarking on a targeted stakeholder engagement process including patient groups and industry, in seeking to bring about further improvements to the reimbursement process.
The membership of the Group includes representatives of the Drugs Group, the HSE, the NCPE, and the Department of Health.
The working group will report on their progress in the autumn.
374. Deputy Patrick Costello asked the Minister for Health the efforts being made by his Department to counter the rising costs of baby formula recognising the necessity of the product for many woman and babies where breastfeeding may be an unviable option; and if he will make a statement on the matter. [27030/23]
View answerArticle 10 of Commission Delegated Regulation (EU) 2016/127 sets out the requirements for promotional and commercial practices for infant formula. This does not make provision for free or low-priced products, samples or any other promotional gifts, to promote the use of infant formula. These measures are designed so that the marketing and distribution of infant formula does not interfere with the protection and promotion of breastfeeding.
Encouraging mothers to breastfeed is a priority for the Department of Health. National health policy, including the Healthy Ireland Framework, the National Maternity Strategy, the Obesity Policy and Action Plan, and the National Cancer Strategy, emphasises the importance of supporting mothers who breastfeed, as well as taking action to increase breastfeeding rates in Ireland.
The HSE Breastfeeding in a Healthy Ireland Action Plan is the framework for progressing supports for breastfeeding in Ireland and compliance with the EU and WHO code is a key action to reduce promotion of infant formula. Additional funding of €1.58m was announced by Stephen Donnelly in May 2021, to fund 24 additional HSE Lactation Consultants thereby providing support to every maternity unit in the country.
It is important that children get the best possible start in life, and this is something all Government partners have prioritised in the Programme for Government. Ireland has a culture of bottle feeding; in order to improve child and maternal health, as well as achieve reductions in childhood obesity and chronic diseases, it is necessary to improve breastfeeding rates. Breastfeeding also has the benefit of avoiding, either totally or in part, the costs associated with the use of breast milk substitutes.
The Department of health are working with other departments to offer a range of supports to vulnerable families. As part of our work on obesity, food and nutrition, this Department is represented on a Food Poverty group which is led by the Department of Social Protection. The free school meal initiative will support up to 230,000 children attending DEIS schools in September of this year.
To date the Government has introduced measures to the value of €12 billion to help ease the burden of inflation being experienced by consumers and businesses. Household transfers, including electricity credits, account for around half of the overall fiscal response, with tax measures accounting for one-third and the remainder is composed of business and other expenditure supports
375. Deputy Mattie McGrath asked the Minister for Health if the newly launched HSE capital plan for building and equipment will cover the construction of community adult day services centres; and if he will make a statement on the matter. [27031/23]
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.
376. Deputy Richard Bruton asked the Minister for Health if he has received submissions raising concerns that future plans of the WHO in coordinating responses to pandemics might overreach the need for local national and community responses; and if he will make a statement on the matter. [27039/23]
View answerThe COVID-19 pandemic demonstrated that the global status quo in terms of pandemic preparedness and response is not adequate and needs revision and as such, Ireland strongly supports a multilateral approach to global health issues with the World Health Organisation (WHO) in a central leadership role.
On 1 December 2021, the members of the World Health Organisation reached consensus to begin the process to negotiate a convention, agreement, or other international instrument to strengthen pandemic prevention, preparedness, and response. Ireland supports the WHO-led process to negotiate a binding legal instrument on pandemic preparedness and response. The aim of such a Pandemic Agreement is to protect public health and to help save lives in the event of future pandemics.
An Intergovernmental Negotiating Body (INB) was established and met for the first time on 24 February 2022. The INB has met five times to date and is due to meet again in July to progress work on drafting the agreement. A progress report was delivered to the 76th World Health Assembly in May, with the aim of adopting the instrument by 2024.
The EU is also a leading proponent of this process and Ireland, along with a majority of EU Member States, is part of the Group of Friends of the Treaty. It should be noted that public health is a shared competence between EU members states and the EU itself. Officials in my Department, working with Ireland's Permanent Representation to the UN in Geneva, are engaging and will continue to engage with other Government Departments, the EU negotiator, and the INB bureau in this process.
The Group of Friends of the Treaty strongly supports an agreement that would foster an all-of-government and all-of-society approach, strengthening national, regional, and global capacities and resilience to future pandemics.
As part of the negotiating process, and to encourage transparency and engagement, the INB has held a number of its meetings in public; Ireland strongly supports this action and welcomes the participation of civil society organisations in this process.
377. Deputy Cathal Crowe asked the Minister for Health the total number of people using Tandem insulin pumps who are aged between 0-17 years and those aged 18 years or greater, in each county, for the year 2022, in tabular form. [27044/23]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
378. Deputy Cathal Crowe asked the Minister for Health the number of new insulin pump starts done in the University of Limerick Hospital Group in people aged between 0-17 years and those aged 18 years or greater, for the years 2019, 2020, 2021, and 2022, in tabular form. [27045/23]
View answer379. Deputy Cathal Crowe asked the Minister for Health the number of new insulin pump starts done in Saolta Hospital Group in people aged between 0-17 years and those aged 18 years or greater, for the years 2019, 2020, 2021, and 2022, in tabular form. [27046/23]
View answerI propose to take Questions Nos. 378 and 379 together.
As this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
380. Deputy Cathal Crowe asked the Minister for Health the number of new insulin pump starts done in Ireland East Hospital Group in people aged between 0-17 years and those aged 18 years or greater, for the years 2019, 2020, 2021, and 2022, in tabular form. [27047/23]
View answer382. Deputy Cathal Crowe asked the Minister for Health the number of new insulin pump starts done in South/Southwest Hospital Group in people aged between 0-17 years and those aged 18 years or greater, for the years 2019, 2020, 2021, and 2022, in tabular form. [27049/23]
View answerI propose to take Questions Nos. 380 and 382 together.
As this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
381. Deputy Cathal Crowe asked the Minister for Health the number of new insulin pump starts done in Dublin Midlands Hospital Group in people aged between 0-17 years and those aged 18 years or greater, for the years 2019, 2020, 2021, and 2022, in tabular form. [27048/23]
View answerIt is interesting when we have Bills where there is large amount of consensus, it often gives us the time in this House to talk about the other issues we would like to address to solve the core issue we are dealing with. I do not think we should underestimate the importance of the Bill. Deputy Catherine Murphy is right that there is always the potential for legislation to be a cheap way of looking like we are trying to solve a problem, but I do not believe that is the case in this situation. The reason I do not believe it is the case is because there is huge merit in this Bill. It is because it has come from the learnings in one of the area-based interventions we have made. We all know that communities themselves know what the solutions are to these issues. The findings of the Greentown study, led by the University of Limerick, identified how children were being groomed into criminal behaviour and the illegal drugs industry. Deputy Ó Ríordáin is spot on here. We have an opportunity in this Dáil to bring together a number of initiatives that I think have significant cross-party support. They are: the Citizens' Assembly on Drugs Use; the intervention by the Taoiseach to propose a child poverty unit within the Department of An Taoiseach; and the previous Taoiseach's, and programme for Government, commitment to roll out area-based interventions, or the north-east inner city model.
383. Deputy Cathal Crowe asked the Minister for Health the number of new insulin pump starts done in Children's Health Ireland for the years 2019, 2020, 2021, and 2022, in tabular form. [27050/23]
View answerAs this is a service issue I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
384. Deputy Cathal Berry asked the Minister for Further and Higher Education, Research, Innovation and Science how he intends to reduce the cost of attending third level education for the academic year 2023-2024; and if he will make a statement on the matter. [26970/23]
View answerI am very aware of the pressures affecting students arising from the cost of living and have taken a number of measures to address this.
In Budget 2023 I secured a package of cost of living supports which saw a significant reduction in the cost of college for third level students and their families.
For students starting their course this September, I have increased grant rates, with all maintenance grant rates increasing by at least 10%. Both the special rate of grant and Band 1, which apply to those with least means have increased by 14%. I was pleased to be able to effect these changes from 1st January this year.
I have taken measures to ensure that more undergraduate students than ever before will now be entitled to a form of support by-
• increasing the income threshold to qualify for the 50% Student Contribution Grant and
• introducing a new Student Contribution Grant of €500 for qualifying families on incomes between €62,000 and €100,000.
I have also increased the amount a student can earn outside of term time, without it counting as income for their grant, to €6,552, and I have enhanced postgraduate supports.
I am actively working to address the challenges faced by students in accessing affordable student accommodation. I have secured Government approval to develop both short and medium term policy responses to activate supply of affordable student accommodation. This policy has resulted in the State directly supporting the construction of over 1,100 new student accommodation units. In addition, my officials are continuing to assess a number of other projects with planning permission for delivery of additional supply.
In the immediate term, my Department supports the campaigns being run by higher education institutions to find accommodation in the private rental sector for students through the Rent a Room or “student digs” in family homes. Recent changes have extended the disregard of income earned under the Rent-a-Room relief to social welfare recipients and applicants under the Student Grant Scheme. The Government has also approved the extension of the disregard for both Medical Card Holders and Local Authority tenants and work is ongoing across the relevant Departments to progress the implementation of these changes. This scheme allows homeowners to earn up to €14,000 per annum in rental income before paying tax.
I will be publishing a cost of education options paper in the coming months which will set out options for further enhancement of student supports for consideration as part of the budgetary process.
