Written Answers Nos. 350-371
350. Deputy David Cullinane asked the Minister for Health to outline any review made regarding the scope and responsibilities of the advisory firms that constitute the design team of the NCH; the nature of the reviews; the dates the reviews were made; and if he will make a statement on the matter. [30365/23]
View answerThe National Paediatric Hospital Development Board (NPHDB) has statutory responsibility for planning, designing, building, and equipping the new children's hospital. I have therefore referred your question to the NPHDB for direct reply.
351. Deputy David Cullinane asked the Minister for Health to outline the full revenue and capital cost of the last community nursing unit built and completed; the date it was opened, the number of beds, the number of staff employed in the unit; the length of time it took from design to completion; the revenue and capital funding allocated each year to the project; and if he will make a statement on the matter. [30366/23]
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.
352. Deputy David Cullinane asked the Minister for Health the average weekly cost of contracting a community step-down or recovery bed; and if he will make a statement on the matter. [30367/23]
View answerAs this is an operational matter, I have asked the Health Service Executive to respond to the deputy directly, as soon as possible.
353. Deputy David Cullinane asked the Minister for Health the different types of community beds contracted by the HSE, broken down by bed type, the number of beds contracted by bed type, the average weekly cost by type, in tabular form; and if he will make a statement on the matter. [30368/23]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
354. Deputy David Cullinane asked the Minister for Health if he is considering a centralised referral system for patients referred into acute hospitals; and if he will make a statement on the matter. [30369/23]
View answerThe 2023 Waiting List Action Plan (WLAP) was published on the 7th of March 2023 and forms the next stage of the new multi-annual approach to reduce and reform hospital waiting lists and times. Under the 2023 Plan, the Department is allocating €363 million to the HSE and NTPF to remove 1.66 million patients from waiting lists, resulting in a projected reduction of 10%, and to further reduce waiting times towards Sláintecare targets (10 weeks for new outpatient appointments and 12 weeks for procedures).
This will build on the 2022 WLAP, in which c.1.56m patients were removed from waiting lists, resulting in a net reduction of c.30,000 (4%) – the first annual decrease in national hospital waiting lists since 2015. In 2022 the numbers waiting over the Sláintecare times also fell by 11%, or 56,000 people. Since the pandemic peaks in 2020/21 there has been a 24% (151,000) reduction in the number of people waiting longer than the Sláintecare times.
As part of the 2023 Waiting List Action Plan, and under one of three key areas ‘Reforming Schedule Care’, Action 17 commits to the establishment by the HSE of patient-centred booking arrangements through a Central Referral’s Office (CRO). This reform initiative seeks to significantly improve patient experience and ensure patients are seen as quickly as possible. The approach involves (i) reforming how referrals are received, triaged and assigned, (ii) increasing patient choice of appointment time and date through partial booking and (iii) establishing a single point of contact for queries relating to referrals or appointments.
In 2022, this initiative was piloted by the HSE at University Limerick Hospital Group and preliminary impacts demonstrated an improvement in caseload balancing and a reduction in the number of patients placed on a waiting list as a result of advanced clinical prioritisation upon receipt of referral. In 2023, patient-centred booking arrangements will be expanded to 9 additional hospital sites (10 hospitals in total), initially including 1-2 specialties.
To date, CROs have been implemented in 4 Hospitals - University Hospital Limerick, Ennis General Hospital, Nenagh General Hospital and Croom Hospital. An additional 3 Hospitals are due to go-live in July - Crumlin, Temple Street and Tallaght Children's Hospital.
The Waiting List Task Force will continue to meet regularly to drive and oversee the delivery of all 30 actions in the 2023 Waiting List Action Plan and provide regular updates to the Minister for Health and the Sláintecare Programme Board.
355. Deputy David Cullinane asked the Minister for Health the number of children with scoliosis waiting for surgery on 1 May 2015, 2016, 2017, 2018, 2019, 2020, 2021, 2022 and 2023, in tabular form; and if he will make a statement on the matter. [30370/23]
View answerIn relation to the particular query raised, as this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
356. Deputy David Cullinane asked the Minister for Health the number of children with spina bifida waiting for surgery on 1 May 2015, 2016, 2017, 2018, 2019, 2020, 2021, 2022 and 2023, in tabular form; and if he will make a statement on the matter. [30371/23]
View answerIn relation to the particular query raised, as this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
357. Deputy David Cullinane asked the Minister for Health if he will consider hiring directly employed GPs, the work that has been carried out in his Department to progress this; and if he will make a statement on the matter. [30372/23]
View answer358. Deputy David Cullinane asked the Minister for Health the number of salaried or directly hired GPs working for the HSE; and if he will make a statement on the matter. [30373/23]
View answer359. Deputy David Cullinane asked the Minister for Health the number of salaried or directly hired GPs hired by the HSE from 2014 to date, broken down by year; and if he will make a statement on the matter. [30374/23]
View answerI propose to take Questions Nos. 357 to 359, inclusive, together.
The Irish model of general practice is based on private practice, and all GPs providing GP services in Ireland currently are private practitioners. The HSE does not directly employ GPs for the provision of GP services.
At present, there are 2,550 GPs who hold a General Medical Scheme (GMS) contract with the HSE to provide services without charge to medical card and GP visit card holders. More than 500 further GPs hold contracts with the HSE other than a GMS contract, such as for screening services or vaccinations. Approximately a further 500 GPs work entirely privately, many of these working as locums to provide support to other GPs.
The Government has taken a number of actions, and has significantly increased investment in general practice, to increase the number of GPs working in the State and to improve access to services. Both interest in general practice training and the number of new entrants undertaking this training have increased in recent years. The number of doctors entering GP training has been increased from 193 in 2019 to 258 in 2022, with 285 places training places planned for this year rising to 350 places next year.
There are however recognised challenges in accessing GPs in some parts of the country, often in rural or more deprived areas and I am open to looking at whether salaried GPs would be a possible solution to such access issues. It should be noted that any proposed model involving salaried GP positions would require careful consideration to ensure the required level of service could be provided for medical card and GP visit card holders.
The Strategic Review of General Practice is to commence shortly and will be completed this year. As part of the review, consideration will be given to the possible role of HSE-employed GPs, as part of a wider examination of the GP capacity issue.
360. Deputy David Cullinane asked the Minister for Health to outline what additional funds were made available to GPs in budget 2023 to assist in delivering additional GP-only cards; how that money was spent; and if he will make a statement on the matter. [30375/23]
View answerThe Government is committed to the expansion of GP visit card eligibility to those who earn the median household income or less, as announced in Budget 2023. The measure will remove the cost of accessing GP care from those for whom cost is most likely to prevent access; with approximately 400,000 additional individuals estimated to become eligible under the expansion.
The funding for the expansion, including funding for a significant package of additional capacity supports for general practice, was provided in Budget 2023 within an extensive €107 million package that included other new cost of living measures. At present the expansion has not commenced, accordingly the funding for the expansion has not been spent. Information in relation to the commencement of the expansion will be provided when available.
361. Deputy David Cullinane asked the Minister for Health when the promised extension of GP-only cards, as announced in budget 2023, will be delivered; and if he will make a statement on the matter. [30376/23]
View answer396. Deputy Emer Higgins asked the Minister for Health when the new increased income threshold for GP-only cards will come into effect; and if he will make a statement on the matter. [30488/23]
View answerI propose to take Questions Nos. 361 and 396 together.
The 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. The measure will remove the cost of accessing GP care from those for whom cost is most likely to prevent access; with approximately 400,000 additional individuals estimated to become eligible under the expansion.
The Department of Health and the Health Service Executive (HSE) are engaged in intensive discussions with the Irish Medical Organisation (IMO), representing GPs, in relation to concerns they have expressed around the roll-out of this increase in eligibility with the intention of securing an agreed pathway to implementation.
Information in relation to the commencement of the expansion will be provided when available.
Furthermore, it is intended to commence the expansion of GP care without charges to all children aged 6 and 7 as early as possible. My officials and the HSE have made preparations for this expansion and engagement is ongoing with the IMO in relation to the necessary fee structures for this service.
362. Deputy David Cullinane asked the Minister for Health to outline any cost-saving measures identified in health in budgets from 2016 to date; the amount of money saved; and if he will make a statement on the matter. [30377/23]
View answerI have set out below the information which is available in relation to savings targets outlined in the Budgets/ National Service Plans for the years 2016 to 2023. In relation to part of the question on the amount of money saved, my officials have referred the question onward to the HSE to populate the estimate of actual savings delivered and I am asking that the HSE should revert directly to you on this.
If you need any additional information, please do not hesitate to contact myself or the Department
2016
Proposed Savings identified €125m
Description of Area of Saving : €15m in the procurement process and €110m targeted reduction in prescribing and drug costs within PCRS
2017
Proposed Savings identified nil
Description of Area of Saving : not applicable
2018
Proposed Savings identified €346m
Description of Area of Saving : Value Improvement Programme Theme 1 €77m. Savings to be sought in the following areas: Acutes €46m, Disability €15m, Older Persons €9m and Primary Care €7m
Value Improvement Programme Theme 2 €119m and Value Improvement Theme 3 €150m.
Value Improvement Programmes Themes 2&3 are whole of system efficiencies that were to be identified
2019
Proposed Savings identified €30m
Description of Area of Saving : Reduction in absenteeism rates, stock and logistics efficiencies, income generation re surplus property assets, reduction in low value/no value care, prioritization of staff travel, additional modernization and prioritization of training and development, campaign spending, community income and PCRS probity and scheme costs
There are other areas detailed in the NSP where lower provision is being made, cost reduction or improved income generation is set out. There are other actions to limit cost growth as well as areas of a technical financial nature that are outlined to provide savings as set out in the NSP which is available to view at the following address.
www.hse.ie/eng/services/publications/serviceplans/national-service-plan-2019.pdf
2020
Proposed Savings identified €125m
Description of Area of Saving : Promoting the switch to biosimilar drugs, sustainability program on community pharmaceutical costs. General efficiencies to support new and existing service costs. Reconfiguration of long terms care beds stock to address value for money issues
2021
Proposed Savings identified €160m
Description of Area of Saving : €90m from past pay arrears settlements, €35m biosimilar savings and €35m overseas treatment
2022
Proposed Savings identified €67m
Description of Area of Saving : Efficiencies in respect of nursing homes cost of care €37m, acutes income €10m and €20m PCRS/biosimilar savings
2023
Proposed Savings identified €49.2m
Description of Area of Saving : This relates to an overall reduction in the workforce targets for 2023 to an overall workforce level of 142,923. This represents a reduction of 769 WTE over the maximum workforce numbers in the 2022.
Several value improvement projects for effectiveness and efficiency have been set up included in the NSP. These are listed below. No monetary savings figure was ascribed in the NSP for these projects.
1. Rostering/Management of overtime and agency
2. Cost of Care in Public Long term nursing homes
3. Reduction in the use of external consultants
4. High- Cost Residential Placements (Disability and Mental Health)
5. Covid 19 responses
6. Private Maintenance income
363. Deputy David Cullinane asked the Minister for Health to outline all secondary non-health benefits associated with having a full medical card; and if he will make a statement on the matter. [30378/23]
View answerThe Health Act 1970 (as amended) provides for two categories of eligibility for persons ordinarily resident in the country, i.e. full eligibility (medical card holders) and limited eligibility (all others). Adults with full eligibility can access a range of services including GP services, prescribed drugs and medicines, public in-patient hospital services, including consultants’ services, all out-patient public hospital services including consultants’ services, dental, ophthalmic and aural services and appliances, and maternity and infant care service.
It is acknowledged that medical card holders have access to some broader services beyond health service however, my Department does not hold information in relation to those schemes.
365. Deputy David Cullinane asked the Minister for Health to outline how the pricing mechanism works to determine the fair deal rate for nursing homes; and if he will make a statement on the matter. [30380/23]
View answerThe Nursing Homes Support Scheme Act 2009 sets out the basis for determining the cost of care in public centres under section 33 of the Act and maximum prices in private centres under section 40.
Cost of care in public centres
In March 2022 the HSE published its annual updated cost of providing care in its public residential care centres for older people.
The report gives detailed cost of care in public nursing homes. It shows that the cost of care has increased from €1,674 per week in 2021 to €1,698 per bed per week in 2022.
The 1.4% increase can be attributed to pay increases provided under the Lansdowne Road Agreement (funded separately to Nursing Homes Support Scheme - NHSS - funds allocated within the HSE Service Plan 2022). These costs do not relate to the amount a person will pay towards their care under the NHSS (Fair Deal) and it is important to note that regardless of whether a nursing home resident is in a private, voluntary or public nursing home their contribution to the cost of their own care remains the same.
The HSE has committed to publishing the required, detailed additional information in respect of publicly provided long-term residential care costs from 2022 onwards. These costs are determined by the HSE and the current cost per bed per week can be found on the HSE website: www2.hse.ie/services/schemes-allowances/fair-deal-scheme/financial-assessment/
Maximum prices in private nursing homes
The National Treatment Purchase Fund (NTPF) has been designated by the Minister for Health pursuant to Section 40 of the Nursing Homes Support Scheme Act 2009 as a body authorised to negotiate with proprietors of non-HSE registered nursing homes to reach agreement in relation to the maximum price(s) that can be charged for the provision of long-term residential care services to NHSS residents. Maximum prices for individual nursing homes are agreed with the NTPF following negotiations and based on the NTPF’s cost criteria.
The objective of the NTPF is to agree a price with each nursing home that offers value for money to the State having regard to the following criteria:
a) the costs reasonably and prudently incurred by the home and evidence of value for money;
b) the price(s) previously charged;
c) the local market price; and
d) budgetary constraints and the obligation of the State to use available resources in the most beneficial, effective and efficient manner to improve, promote and protect the health and welfare of the public
The NTPF carry out this role independently under the NHSS Act 2009. The NTPF has statutory independence, and there is no role for Ministers or the Department of Health in these negotiations.
The Department of Health published a review of the NTPF pricing system in June 2021. A steering group has been established to oversee the delivery of the recommendations; this group has met on a regular basis since publication of the review and continues to work on taking these recommendations forward.
The Government remains committed to ensuring that long-term residential care for older people continues to place residents’ care, wellbeing, standards and best interests at the centre of development.
The Department of Health continues to engage with the NTPF to examine ways in which funding can be used to provide support to nursing homes. In addition, the NTPF will shortly be seeking up-to-date financial and operational information from nursing homes to inform further analysis and considerations of measures to support the sector.
366. Deputy David Cullinane asked the Minister for Health to outline, in tabular form, the average weekly cost of care in HSE nursing homes; the average weekly cost of care in private or voluntary nursing homes; the percentage differential between the average weekly cost of public versus private-voluntary homes, further broken down by county; and if he will make a statement on the matter. [30381/23]
View answerAs these are operational matters, I have asked the Health Service Executive to respond to the deputy directly, as soon as possible.
368. Deputy David Cullinane asked the Minister for Health who is responsible for tracking availability of medicines, issuing warnings if there are shortages and monitoring supply of medicines; and if he will make a statement on the matter. [30384/23]
View answerThe medicines regulator in Ireland is the Health Products Regulatory Authority (HPRA). The remit and regulatory functions of the HPRA include human and veterinary medicines, clinical trials, medical devices, controlled drugs, blood and blood components, tissues and cells, and cosmetic products.
The Department of maintains regular contact with the HPRA regarding medicines shortages. Ireland has a multi-stakeholder Medicine Shortage Framework in place which aims to prevent, where possible, and mitigate the impact of medicines shortages through close collaboration with the Department, the HSE, industry and healthcare professionals. The Framework is operated by the Health Products Regulatory Authority (HPRA) on behalf of the Department of Health.
Pharmaceutical companies and wholesalers must ensure an appropriate and continuous supply of the medicines they market. Companies should notify the HPRA of medicines shortages or potential shortages impacting the Irish market. Any healthcare professional or member of the public may also report a shortage to the HPRA.
The HPRA publishes a list of medicines currently in short supply on its website (Medicines Shortages (hpra.ie)) with the reason for the shortage and expected dates for the return of supply. The information is available to assist healthcare professionals in managing medicine shortages when they arise and reduce their impact on patients. The information relating to shortages on the HPRA website is dynamic and changes depending on the current information.
369. Deputy David Cullinane asked the Minister for Health who reports to him regarding medicine shortages; what reports of shortages he received in 2022 and to date in 2023; to outline the nature and date of the reporting; and if he will make a statement on the matter. [30385/23]
View answerOfficials in my department report to me regarding medicines shortages and I am aware and fully up to date on medicine shortages.
The medicines regulator in Ireland is the Health Products Regulatory Authority (HPRA). The Department of Health maintains regular contact with the HPRA regarding medicines shortages. The HPRA publishes a list of medicines currently in short supply on its website (Medicines Shortages (hpra.ie)) with the reason for the shortage and expected dates for the return of supply. The information is available to assist healthcare professionals in managing medicine shortages when they arise and reduce their impact on patients. The information relating to shortages on the HPRA website is dynamic and changes depending on the current information.
Pharmaceutical companies and wholesalers must ensure an appropriate and continuous supply of the medicines they market in Ireland. Companies should notify shortages or potential shortages of medicines to the HPRA and the HSE.
Patients and healthcare professionals can also assist by reporting possible shortages not currently included on the HPRA shortages list.
All those in the medicines supply chain can play a role in preventing and effectively managing product shortages. This is a key goal of the multi-stakeholder medicine shortages framework.
370. Deputy David Cullinane asked the Minister for Health if he is considering the introduction of a serious shortage protocol regarding medicine supply; and if he will make a statement on the matter. [30386/23]
View answerIn other jurisdictions outside of Ireland Serious Shortages Protocols (SSP) are used to facilitate community pharmacists to supply either an alternative quantity, strength, pharmaceutical form, or medicine. Legislation in Ireland already allows for generic substitution (alterative strengths, quantity and forms) but does not allow for therapeutic substitution.
Shortages protocols are product specific and are only used in very limited situations. For example, in the UK every draft SSP is reviewed by NHS England’s National Medical Director and Chief Pharmaceutical Officer, who can suggest amendments and raise any potential safety concerns, and Ministerial authorisation is necessary to give effect to the protocol. Each SSP is time limited.
The Department of Health is scoping the introduction of a similar framework, a limited stock supply framework (LSS) in Ireland which will only be used in certain emergency situations such as shortages. This is the case in all other countries that have a protocol in place. Legislative amendments will be required.
There are risks associated for both the pharmacist and patient with substituting prescriptions and the Department will need to be satisfied that these risks are addressed which will impact the timeframe for implementation. An initial proposal on implementation of this policy option is complete and work to develop the governance, legal, training and patient safety aspects of this proposal will be completed this year. The Department will engage with key stakeholders as this policy is developed.
