Tuesday, 4 Jul 2023

Written Answers Nos. 560-576

Cancer Services

Questions (560)

Gino Kenny

Question:

560. Deputy Gino Kenny asked the Minister for Health if he plans to lower the breast cancer screening age below the current level of 50 to 40 or 45 years; and if he will make a statement on the matter. [32049/23]

Written answers

Minister for Health

I am fully committed to supporting our population screening programmes which are a valuable part of our health service, enabling early treatment and care for many people, and improving the overall health of our population.

Under commitments in the Programme for Government, BreastCheck eligibility has been expanded to women aged 69 years since 2021. The Programme for Government also commits to expanding the age range for BowelScreen to those aged 55 to 74, and the HSE plans to commence this in 2023 with expansion to those aged 59, in addition to the current age range of 60 to 69.

Any decisions about further changes in cancer screening, including further extension of the age ranges, will be made on the advice of the National Screening Advisory Committee (NSAC). This independent expert group considers and assesses evidence in a robust and transparent manner, and against internationally accepted criteria. It is important we have rigorous processes in place to ensure our screening programmes are effective, quality assured and operating to safe standards, and that the benefits of screening outweigh the harms.

I am pleased to report that the Committee is already progressing work on the further expansion of our cancer screening programmes, and has asked HIQA to evaluate the evidence for the further expansion of the age range eligibility for both the BowelScreen and BreastCheck programme.

Under Europe’s Beating Cancer Plan, an updated European Council Recommendation on cancer screening was published in December 2022. The updated Recommendation recommends extended screening for colorectal (bowel) cancer and breast cancer, along with other recommendations in relation to cervical, lung, prostate and gastric cancer screening. The NSAC will consider this Recommendation and advise me and the Department of Health on the evidence as it applies to Ireland.

Ireland will also be actively engaged with the significant ongoing collaborative work at European level to take forward the updated Recommendation on cancer screening.

Question No. 561 answered with Question No. 552.

Medical Aids and Appliances

Questions (562)

Michael Healy-Rae

Question:

562. Deputy Michael Healy-Rae asked the Minister for Health when a wheelchair will be provided to a person (details supplied); and if he will make a statement on the matter. [32086/23]

Written answers

Minister for Health

As the Health Service Executive (HSE) have responsibility for the provision of aids and appliances, including wheelchairs, under the Community Funded Schemes, I have asked HSE to respond to the Deputy directly as soon as possible.

Hospital Appointments Status

Questions (563)

Michael Healy-Rae

Question:

563. Deputy Michael Healy-Rae asked the Minister for Health if an earlier appointment will be given to a person (details supplied); and if he will make a statement on the matter. [32087/23]

Written answers

Minister for Health

As this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.

Medical Cards

Questions (564)

Paul Donnelly

Question:

564. Deputy Paul Donnelly asked the Minister for Health if he will provide an update on the cancellation of a national contract that will make vasectomies no longer available on a medical card in seven counties including north County Dublin. [32094/23]

Written answers

Minister for Health

As this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.

Health Services Staff

Questions (565, 566)

Mairéad Farrell

Question:

565. Deputy Mairéad Farrell asked the Minister for Health what assistance is given to non-EEA healthcare assistants when moving to Ireland as well as what support is given for family reunification; and if he will make a statement on the matter. [32095/23]

Mairéad Farrell

Question:

566. Deputy Mairéad Farrell asked the Minister for Health the assistance that is given to non-EEA healthcare assistants when moving to Ireland; the support that is given for family reunification; and if he will make a statement on the matter. [32096/23]

Written answers

Minister for Health (Deputy Stephen Donnelly)

I propose to answer Questions Nos. 565 and 566 together.

Access to the General Employment Permit for non-EEA nationals wishing to take up employment in the role of health care assistant was announced in June 2021 to address skills and labour shortages in the healthcare and nursing home sector. The framework agreed following constructive engagement with the Department of Health provided a salary of at least €27,000 for the role and the requirement for the permit holder to attain a relevant qualification at least QQI Level 5 after 2 years employment in the State.

Remuneration for employment permit purposes is a labour market policy instrument in which setting minimum remuneration thresholds is a delicate balancing act. Economic migration seeks to serve the skills needs of the economy without impacting the wider labour market. Therefore, being cognisant that there are a range of remuneration levels in the sector (€24,000 - €32,000) and recognising the need to be able to recruit staff while ensuring that there is no disruption to the domestic labour market, a minimum annual remuneration threshold of €27,000 has been set for this occupation.

The conditions governing the eligibility requirements for family reunification and the granting of Stamp 1G visas for spouses and/or dependents of employment permit holders are a matter for the Minister for Justice. The Department of Justice policy requires that the sponsor demonstrate their capacity to provide for their family member(s) if they are to be granted a permission to come to Ireland. The policy sets out the rationale for applying resource requirements as part of the overall assessment of whether to approve an application for family reunification and the conditions attaching to permissions issued to family members. The Policy, which was last amended in 2016, is currently under review. Information regarding financial resources for family reunification is outlined in the policy document available at the following link; www.irishimmigration.ie/wp-content/uploads/2021/04/Policy-document-on-Non-EEA-family-reunification.pdf

Question No. 567 answered with Question No. 552.

Hospital Appointments Status

Questions (568)

Maurice Quinlivan

Question:

568. Deputy Maurice Quinlivan asked the Minister for Health if he will provide an update on the case of a person (details supplied) who was referred by their GP to the dermatology service at University Hospital Limerick three years ago and has yet to receive an appointment; and if he will make a statement on the matter. [32099/23]

Written answers

Minister for Health

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.

Medical Cards

Questions (569)

Paul Kehoe

Question:

569. Deputy Paul Kehoe asked the Minister for Health what criteria are used for applicants who suffer with cancer to obtain a medical card; the reason some people qualify and others (details supplied) are refused; and if he will make a statement on the matter. [32100/23]

Written answers

Minister for Health

Medical 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.

With regard to the specific application in the details supplied, as this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.

Medical Cards

Questions (570)

Jackie Cahill

Question:

570. Deputy Jackie Cahill asked the Minister for Health if he intends to increase the income threshold for the over-70s medical card in Budget 2024; if he would take this into consideration; and if he will make a statement on the matter. [32101/23]

Written answers

Minister for Health

Eligibility 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.

Hospital Appointments Status

Questions (571)

Maurice Quinlivan

Question:

571. Deputy Maurice Quinlivan asked the Minister for Health if he will provide an update on the case of a person (details supplied) who was referred by their GP in October 2022 to the diabetic outpatient service at University Hospital Limerick, and has yet to receive an appointment; and if he will make a statement on the matter. [32102/23]

Written answers

Minister for Health

As this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.

Medical Cards

Questions (572)

Pearse Doherty

Question:

572. Deputy Pearse Doherty asked the Minister for Health the reason for the delay in providing prescribed solpadine for holders of a medical card; and if he will make a statement on the matter. [32116/23]

Written answers

Minister for Health

The Health Service Executive (HSE) has statutory responsibility for decisions on pricing and reimbursement of medicines under the Community Drug Schemes, in accordance with the provisions of 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 (EMA) or the Health Products Regulatory Authority (HPRA).

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.

The HSE advise that Solpadeine capsules in packs of 32 and Solpadeine Soluble tablets in packs of 60 are currently on the reimbursement list.

Chefaro Ireland DAC, the company responsible for supplying Solpadeine, has notified of a shortage of Solpadeine Soluble Tablets (12 and 60 pack) and Solpadeine Capsules (12, 24 and 32 pack). These shortages are affecting multiple countries and the company has stated that the shortages of the soluble tablets are due to manufacturing delays. The company anticipates Solpadeine Soluble Tablets 60 pack to return in October 2023 and the 12 pack to return in November 2023. Solpadeine Capsules 12 pack is expected to return in August 2023, the 24 pack in September 2023 and the 32 pack in July 2023.

The company has confirmed that stock of Solpadeine Soluble Tablets (24 pack) remains available in the interim.

Under the Drugs Payment Scheme (DPS), 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. The DPS significantly reduces the cost burden for families and individuals with ongoing expenditure on medicines.

DPS card holders should be able to access Solpadeine capsules in packs of 32 and Solpadeine Soluble tablets in packs of 60 as soon as they become available, provided that these have been prescribed by a clinician. To access other Solpadeine products which are in stock but not on the reimbursement list, they would have to pay.

Unfortunately, medicine shortages are a feature of modern health systems worldwide which have been exacerbated by recent worldwide events. There are a multitude of reasons why a medicine may not be available including: shortages of raw materials; manufacturing difficulties; sudden unexpected increase in demand; or product recalls due to potential quality issues.

Ireland has a multi-stakeholder medicine shortage framework in place, coordinated by the Health Products Regulatory Authority (HPRA), to prevent, wherever possible, and to manage medicine shortages when they occur. The HPRA maintains regular contact with the Department of Health regarding medicines shortages.

The HPRA publishes a list of medicines currently in short supply on its website with the reason for the shortage and expected dates for the return of supply. See www.hpra.ie/homepage/medicines/medicines-information/medicines-shortages .

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 the HPRA has to hand.

Health Services Staff

Questions (573)

Paul Kehoe

Question:

573. Deputy Paul Kehoe asked the Minister for Health for an update on funding available to psychology trainees undertaking doctorates for counselling and education psychology, now the current academic year is pending and fees have to be paid; and if he will make a statement on the matter. [32119/23]

Written answers

Minister of State at the Department of Health

As the Deputy will be 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 focused on supporting counselling psychology students in an equitable way and that delivers value for money. The structure of this funding is still 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 required 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.

In relation to the question raised, the Deputy may wish to seek the view of the Minister for Education as regards funding opportunities for educational psychologists.

Regulatory Bodies

Questions (574)

Mairéad Farrell

Question:

574. Deputy Mairéad Farrell asked the Minister for Health if he is aware of the situation in CORU whereby there is a four-month deadline to evaluate applications, but no fixed deadline for evaluating appeals, and if he has had any discussions with CORU in relation to this issue as a potential bottleneck in the processing of applications and recruitment, and possible additional resourcing CORU may need. [32129/23]

Written answers

Minister for Health

As the Deputy will appreciate health professional regulators must apply high standards to the assessment of applications for registration from those who wish to work in our health services. This process must be robust to ensure patient safety but must also be fair to applicants. I am advised that the number of appeals in a given year is extremely small, typically in the order of 1.5% to 7%. Imposing a deadline for appeals is potentially problematic as appeals are often successful following the submission of additional information by the candidate. CORU strives to reach their decisions in the shortest timeframe possible and officials in my Department continue to engage with them on a regular basis regarding recognition and registration timelines generally. CORU has been provided with substantial additional resources over the past number of years to assist it fulfil its functions as set out under the Health and Social Care Professionals Act 2005 and of course this will continue to be kept under review.

Health Services

Questions (575, 663)

Denis Naughten

Question:

575. Deputy Denis Naughten asked the Minister for Health the current status of the plan for publicly funded IVF as announced in Budget 2023, with €10 million being allocated by the then finance Minister, as there is a lack of clarity as to how the plan will be implemented which is causing fertility patients serious concern; and if he will make a statement on the matter. [32135/23]

Paul McAuliffe

Question:

663. Deputy Paul McAuliffe asked the Minister for Health the status of funding for IVF as announced in Budget 2023; and if he will make a statement on the matter. [32637/23]

Written answers

Minister for Health

I propose to take Questions Nos. 575 and 663 together.

As the Deputy will be aware, a commitment to “introduce a publicly funded model of care for fertility treatment” is included in the Programme for Government. The Model of Care for Fertility was developed by the Department of Health in conjunction with the HSE’s National Women & Infants Health Programme (NWIHP) in order to ensure that fertility-related issues are addressed through the public health system at the lowest level of clinical intervention necessary. This Model of Care comprises three stages, starting in primary care (i.e. GPs) and extending into secondary care (i.e., Regional Fertility Hubs) and then, where necessary, tertiary care (i.e. IVF (in-vitro fertilisation), ICSI (intra-cytoplasmic sperm injection) and other advanced assisted human reproduction (AHR) treatments), with patients being referred onwards through structured pathways.

Phase One of the roll-out of the Model of Care has involved the establishment, at secondary care level, of Regional Fertility Hubs within maternity networks, in order to facilitate the management of a significant proportion of patients presenting with fertility-related issues at this level of intervention. Patients are referred by their GPs to their local Regional Fertility Hub, which provides a range of treatments and interventions for both males and females, including: relevant blood tests, semen analysis, assessment of tubal patency, hysteroscopy, laparoscopy, fertility-related surgeries, ovulation induction and follicle tracking.

There are currently five out of six Regional Fertility Hubs in service and the completion of Phase One of the roll-out of the Model of Care, envisaged for later this year, will result in fully operational Regional Fertility Hubs at six locations across the country.

Phase Two of the roll-out of the Model of Care will see the introduction of tertiary fertility services, including IVF, provided through the public health system. In this regard, funding was secured in Budget 2023 to support access to advanced AHR treatments, including, crucially, to allow the commencement of Phase Two of the roll-out of the Model of Care.

This investment will facilitate the first steps to be taken towards the provision of a complete publicly-provided fertility service, which is the ultimate objective of Government. In particular, it will allow the historic development of the first National Advanced AHR Centre, delivering IVF and ICSI through a wholly public clinic and is scheduled to open in 2024. Subject to the provision of additional funding in future, it is envisaged that additional National Advanced AHR Centres will be developed and become operational on a phased basis elsewhere in the country.

The 2023 allocation is also being utilised to support the Regional Fertility Hubs in order to expand the scope of services by introducing the provision of IUI (intrauterine insemination), which can, for certain cohorts of patients, be a potentially effective, yet less complex and less intrusive, type of AHR treatment.Separately, as an interim measure, I have instructed that some funding be made available to support access to advanced AHR treatment via private providers from September 2023.

My officials, in conjunction with NWIHP, are continuing to actively prepare for the operationalisation of both the publicly- and privately- provided service, including finalising access criteria and determining how the interim funding for private treatments will be provided to individual eligible patients. The design and scope of this final phase of the Model of Care for Fertility have not yet been finalised, but I am hopeful to be in a position to provide more specific details shortly.

My Department and the Government is fully committed, through the full implementation of the Model of Care for Fertility, to ensuring that patients always receive care at the appropriate level of clinical intervention and then those requiring, and eligible for, advanced AHR treatment such as IVF will be able to access same through the public health system. The underlying aim of the policy to provide a model of funding for AHR, within the broader new AHR regulatory framework, is to improve accessibility to AHR treatments, while at the same time embedding safe and appropriate clinical practice and ensuring the cost-effective use of public resources.

Healthcare Policy

Questions (576)

Jackie Cahill

Question:

576. Deputy Jackie Cahill asked the Minister for Health if there is a prohibition on price discounting or special offers for infant formula in Irish shops; and if he will make a statement on the matter. [32147/23]

Written answers

Minister for Health

The regulatory requirements for promotional and commercial practices for infant formula are set out in Article 10 of Commission Delegated Regulation (EU) 2016/127. This Article prohibits point-of-sale advertising, giving of samples or any other promotional device to induce sales of infant formula directly to the consumer at the retail level. This includes price discounting, special offers, special displays, discount coupons, premiums, special sales, loss-leaders and tie-in sales. These measures are designed so that the marketing and distribution of infant formula does not interfere with the protection and promotion of breastfeeding.

A priority for both the Department of Health and the HSE is to encourage more mothers to breastfeed. 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.

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; to improve child and maternal health, as well as achieve reductions in childhood obesity and chronic diseases, it is necessary to improve breastfeeding rates.

The HSE Breastfeeding in a Healthy Ireland Action Plan is the framework for progressing supports for breastfeeding in Ireland. One key action in the framework is to strengthen compliance with the International Code of Marketing of Breast Milk Substitutes and subsequent World Health Assembly resolutions. A HSE Policy for staff on the Marketing of Breast Milk Substitutes came into effect in October 2021. It requires that all services comply with the International Code.