Tuesday, 11 Jul 2023

Written Answers Nos. 679-693

Health Strategies

Questions (679)

Patrick Costello

Question:

679. Deputy Patrick Costello asked the Minister for Health the actions his Department is taking to improve breastfeeding supports and postpartum care; and if he will make a statement on the matter. [33534/23]

Written answers

Minister of State at the Department of Health

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 Minister Donnelly in May 2021, to fund 24 additional HSE Lactation Consultants thereby providing support to every maternity unit in the country.

There are currently 55 dedicated lactation posts employed in the HSE, with 35.5 working in maternity services and 19.5 working in the community. 30.5 of the 34.5 of the new lactation posts approved by the DOH and the HSE’s National Women and Infants Health Programme in 2021 have been appointed. The capacity to support infant feeding as part of core child health services and supports will be increased significantly with investment in a dedicated child health workforce as recommended within First 5 strategy and Sláintecare actions.

Work is ongoing to progress priority and outstanding actions within the National Breastfeeding Action Plan 2016-2021. The plan was extended to 2023 as a result of the Covid Pandemic. The HSE’s National Breastfeeding Implementation Group (NBFIG) will undertake a review of progress against the current plan in conjunction with relevant stakeholders.

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 National Maternity Strategy proposes a new model of integrated care that provides three care pathways: Supported Care, Assisted Care and Specialised Care. The pathways are designed to ensure that every woman can access the right level of care, from the right professional, at the right time and in the right place, based on her needs. Under the Strategy’s model of care, all 19 maternity services now offer the Supported Care Pathway, and an Advanced Midwife Practitioner (AMP) is in place to implement the pathway in all 19 sites. The HSE’s National Women & Infants Health Programme (NWIHP) has advised that, within this pathway, responsibility for the co-ordination of care to a woman will be assigned to a named Clinical Midwife Manager (CMM), and care will be delivered by the community midwifery team, with most antenatal and postnatal care being provided in the community and home settings.

Upwards of 24% of women are booking on this pathway, demonstrating the increased choice now available to women accessing maternity care which is a central vision of the Strategy, and also an increase in care being provided in the community and closer to home. In addition, 15 maternity units are providing early transfer home and 15 units also have new home-away-from-home delivery suites, supporting increased choice for women.

NWIHP has also advised that, on average, mothers and their babies spend 2-3 days on postnatal wards post birth, with a number of mothers being discharged earlier to the care of the public health nursing services. The NWIHP has finalised a framework for the development of five postnatal hubs, which are intended to move this essential care back to the community supported by a comprehensive and multidisciplinary package of resources and for the duration of the postpartum period. The NWIHP has advised that recruitment is underway for all five postnatal hubs and they will be located in Kilkenny, Kerry, Cork, Portiuncula and Sligo. These hubs will support women for up to 14 days post birth by addressing many of the gaps identified by women in postnatal care including education, breastfeeding, physiotherapy, emotional and physical supports.

In relation to other maternity supports for women, work is ongoing on the implementation of the Model of Care for Specialist Perinatal Mental Health Services as a key priority under Sharing the Vision , our national mental health policy. Perinatal mental health services have now been developed in all maternity units/hospitals and provide specialist support to women experiencing mental health problems in pregnancy. Perinatal mental health disorders are those which complicate pregnancy (antenatal) and the first postnatal year.

Women are now asked specific questions about their mental health as well as their physical health at maternity hospital booking clinic appointments. Women can talk to their midwife and ask for support from the perinatal mental health midwife in their hospital if needed. The GP and Public Health Nurse can also provide support and signposting to the most relevant service for each woman.

Hospital Waiting Lists

Questions (680)

David Cullinane

Question:

680. Deputy David Cullinane asked the Minister for Health when a child (details supplied) can expect to have an MRI conducted; and if he will make a statement on the matter. [33535/23]

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.

Mental Health Policy

Questions (681)

Neasa Hourigan

Question:

681. Deputy Neasa Hourigan asked the Minister for Health if he will outline in what way the removal of the locked status of unit 3, St. Stephen's Hospital, as reported by the Mental Health Commission in November 2022, can compensate alone for the broader loss of other quality-of-life benefits incurred by a resident who was moved to that ward in July 2022 from another approved centre in breach of a condition of its registration; and if he will make a statement on the matter. [33536/23]

Written answers

Minister of State at the Department of Health

Both the Government and the HSE value the regulation of our mental health services as it provides a framework in which to constantly review and improve our services, so they remain person-centred. The Government values the role of the MHC, which is to promote high standards and good practice in mental health services. It is positive to note there has been an overall improvement in compliance in recent years. However, it is acknowledged that further improvement is needed. We will continue to work closely with both the MHC and HSE to improve mental health services in line with STV.

The HSE requires each Centre to provide a Corrective And Preventative Action Plan to address any concerns raised by the MHC.

This is a matter for the HSE as the registered proprietor of the centre, and I have asked them to reply directly to the deputy in this context as soon as possible. The Mental Health Commission welcomes all actions by providers that improve the care and welfare of residents.

Mental Health Policy

Questions (682)

Neasa Hourigan

Question:

682. Deputy Neasa Hourigan asked the Minister for Health if he will outline how the Mental Health Commission can reconcile concerns it raised in its annual report from June 2022 regarding 2,000 people living in congregated settings with their approval in court in November 2022 of HSE proposals to build a 50-bed continuing care and rehabilitation service on the isolated grounds of St. Stephen's Hospital, Glanmire; under which mental health policy the Mental Health Commission made this approval; in what way this can be said to offset any of the disadvantages incurred by a resident who was moved to unit 3, St. Stephen's Hospital from another approved centre in breach of a condition on the registration of unit 3; and if he will make a statement on the matter. [33537/23]

Written answers

Minister of State at the Department of Health

The Mental Health Commission annual report provides an important independent insight into where we are performing well and where improvement is required. In 2022, overall compliance across 31 Regulations was 88.37% compared with 80.04% in 2019, thus indicating an overall improvement of 8.33%. The HSE is reviewing the report and has in place various initiatives currently underway to address many of the recommendations made. Each Centre will provide a Corrective And Preventative Action Plan to address concerns.

Both the Government and the HSE value the regulation of our mental health services as it provides a framework in which to constantly review and improve our services, so they remain person-centred. The HSE is progressing a wide range of capital initiatives for Mental Health Services, including improving residential facilities to meet MHC compliance standards. Funding allocation for Mental Health Capital initiatives has increased to €27.32m in 2023, from €15m in 2022.

The Government values the role of the MHC, which is to promote high standards and good practice in mental health services. It is positive to note there has been an overall improvement in compliance in recent years. However, it is acknowledged that further improvement is needed. We will continue to work closely with both the MHC and HSE to improve mental health services in line with STV.

The statement in the 2022 Mental Health Commission Annual Report (published in June 2023), is a matter of fact by the Inspector of Mental Health Services. The construction of new HSE mental health facilities, including their intended use and purpose, is a matter for the HSE and I have asked them to reply directly to the deputy in this context as soon as possible. If any such unit is constructed, the registered proprietor can then apply to the MHC for registration as an approved inpatient mental health centre.

Mental Health Services

Questions (683)

Pádraig O'Sullivan

Question:

683. Deputy Pádraig O'Sullivan asked the Minister for Health when a child (details supplied) will receive an appointment from CAMHS, given that their situation is deteriorating; and if he will make a statement on the matter. [33543/23]

Written answers

Minister of State at the Department of Health

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

Medicinal Products

Questions (684, 686)

Colm Burke

Question:

684. Deputy Colm Burke asked the Minister for Health given the low approval rates for certain medicines subject to managed access protocols, if he believes that the criteria is currently too restrictive; his views on whether the current criteria could deter eligible patients from applying to access such medicines; and if he will make a statement on the matter. [33544/23]

Colm Burke

Question:

686. Deputy Colm Burke asked the Minister for Health his views on whether managed access protocols for certain medicines should be amended if they are found not to be accommodating to clinicians and patients; and if he will make a statement on the matter. [33546/23]

Written answers

Minister for Health

I propose to take Questions Nos. 684 and 686 together.

The HSE has statutory responsibility for decisions on pricing and reimbursement of medicines under the community drugs schemes, in accordance with the Health (Pricing and Supply of Medical Goods) Act 2013.

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). There are formal processes which govern applications for the pricing and reimbursement of medicines, and new uses of existing medicines, to be funded and/or reimbursed.

The HSE-Drugs Group is the national committee which the HSE has in place to make recommendations on the pricing and reimbursement of medicines. The membership of the HSE-Drugs Group includes public interest members. The totality of clinical and economic evidence for a new medicine is comprehensively and extensively reviewed by the HSE-Drugs Group and a recommendation is then made. In cases where there is a high drug cost or a high potential budget impact or where only a subset of the licensed population has been put forward for consideration, the HSE-Drugs Group may recommend reimbursement subject to the establishment of a HSE-Medicines Management Programme (MMP)-led managed access protocol, in line with Section 20 of the Health (Pricing and Supply of Medical Goods) Act 2013.

The decision-making authority in the HSE is the HSE-Executive Management Team (EMT). The HSE-EMT decides on the basis of all the demands it is faced with (across all services) whether it can fund a new medicine, or new uses of an existing medicine, from the resources that have been provided to it in line with the Health (Pricing and Supply of Medical Goods) Act 2013. The HSE-EMT will make the final reimbursement recommendation.

When a managed access protocol is recommended the HSE-MMP will develop an individual patient approval system based on EMT recommendation and Drugs Group considerations and will ensure it is in line with the reimbursement approval agreement. This will ensure that reimbursement is available for patients who meet the pre-defined criteria as per a HSE-MMP devised managed access protocol.

Managed access protocols may be considered for amendment if the Marketing Authorisation Holder (MAH) submits additional information to the HSE for consideration (e.g. different subgroup(s) from those submitted with the initial pricing and reimbursement application) or if clinical evidence emerges which may impact on the approved HSE reimbursement criteria. In such cases the HSE can consider the updated information, along with information including cost-effectiveness evidence available and the potential budget impact to facilitate an informed decision.

Medicinal Products

Questions (685)

Colm Burke

Question:

685. Deputy Colm Burke asked the Minister for Health given the long wait times that patients experience for medicines subject to managed access protocols, if he can provide further details, in tabular form, on the timelines, from EMA approval to reimbursement, for all medicines subject to managed access protocols for the period May 2021 to April 2023; and if he will make a statement on the matter. [33545/23]

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.

Question No. 686 answered with Question No. 684.

Medicinal Products

Questions (687)

Colm Burke

Question:

687. Deputy Colm Burke asked the Minister for Health the specific drugs that have been considered to date by the rare diseases technology review committee of the HSE, in tabular form; the outcomes of these decisions; the timelines for each from EMA licence to availability to Irish patients; and if he will make a statement on the matter. [33547/23]

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 (688)

Colm Burke

Question:

688. Deputy Colm Burke asked the Minister for Health if his Department would consider increasing the income level for medical card qualification; and if he will make a statement on the matter. [33565/23]

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.iePersons 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 €1,050 for a couple. This increase ensures that a greater proportion of those aged 70 and over now 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 wish to assure the Deputy that, 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 changes are considered in the context of Government policy, the annual budgetary estimates process and other issues which may be relevant.

Special Educational Needs

Questions (689)

Jennifer Murnane O'Connor

Question:

689. Deputy Jennifer Murnane O'Connor asked the Minister for Health when an appointment will be provided for occupational therapy for a person (details supplied); and if he will make a statement on the matter. [33567/23]

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.

Healthcare Policy

Questions (690)

Willie O'Dea

Question:

690. Deputy Willie O'Dea asked the Minister for Health when the income limit for the GP visit card will be increased to include people on a median household income of €46,000 or less, as announced in Budget 2023; and if he will make a statement on the matter. [33574/23]

Written answers

Minister for Health

On the 4 of July last, I confirmed that eligibility for GP visit cards will be extended to people who earn up to the median household income. Approximately 430,000 additional persons, who otherwise would have attended their GP on a private basis, are expected to become eligible for free GP care under this expansion, the largest expansion in GP care without charges in the history of the State.

The income limits will be increased in two phases in order to allow for an orderly roll-out of the service. The first phase of the roll-out will commence on 11 September next, and the second and final phase will commence on 13 November next.

This expansion in care will be implemented with the agreement of the IMO and will put in place a series of capacity supports to allow GPs to recruit additional staff, as well as increases in fees to take account of the likely increase in demand for services. The total financial package will amount to approximately €130 million in a full year.

Departmental Staff

Questions (691)

Violet-Anne Wynne

Question:

691. Deputy Violet-Anne Wynne asked the Minister for Health to provide the names and contact information of all special advisers to Ministers and Ministers of State within his Department; and if he will make a statement on the matter. [33585/23]

Written answers

Minister for Health

The requested information relating to advisers in my Department is available on the Department of Public Expenditure and Reform (DPER) website at the following link:

www.gov.ie/en/publication/9ad159-special-advisers-pay/

Staff emails in the department are structured as [e-mail] and advisers can be contacted in this manner.

Hospital Services

Questions (692)

Violet-Anne Wynne

Question:

692. Deputy Violet-Anne Wynne asked the Minister for Health the number of patients who left the accident and emergency department at University Hospital Limerick without being seen, in the years 2019 to 2022 and to date in 2023, by month, in tabular form; and if he will make a statement on the matter. [33594/23]

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 (693)

Matt Carthy

Question:

693. Deputy Matt Carthy asked the Minister for Health the reason a person (details supplied) was refused a long-term illness card when an ADHD assessment was submitted with the application; and if he will make a statement on the matter. [33596/23]

Written answers

Minister for Health

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