Written Answers Nos. 1105-1124
1105. Deputy Steven Matthews asked the Minister for Health if additional funding will be considered to provide HRT for free to all those who require this treatment; and if he will make a statement on the matter. [35649/23]
View answerThe Health Service Executive (HSE) has statutory responsibility for pricing and reimbursement decisions under the community drug schemes, in accordance with the Health (Pricing and Supply of Medical Goods) Act 2013.
Some Hormone Replacement Therapy (HRT) medications are available to medical card holders under the General Medical Services (GMS) Scheme, subject to payment of the statutory prescription charge.
These same HRT medications are also available under the Drug Payment Scheme (DPS). The DPS ensures that no individual or family pays more than €80 a month towards the cost of approved prescribed medicines. The DPS is not means tested and is available to anyone ordinarily resident in Ireland. The DPS significantly reduces the cost burden for families and individuals with ongoing expenditure on medicines.
While there are no current plans to make the provision of HRT medications free of charge, the removal of VAT from non-oral forms of HRT since 1 January 2023 has also improved access to HRT for those who need it.
1106. Deputy Pádraig Mac Lochlainn asked the Minister for Health if he will request the Northern Ireland Planned Healthcare Scheme to release documentation held in respect of a person (details supplied) in relation to the reimbursement sought after a procedure in a hospital; and if he will make a statement on the matter. [35650/23]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
1108. Deputy Paul McAuliffe asked the Minister for Health to clarify approximately how many doctors have qualified in Ireland over the past three years; the number of those who remain in the country; and if he will make a statement on the matter. [35666/23]
View answerThe Medical Council is the custodian of the register of registered medical practitioners. By law all doctors are required to register with the Council in order to practise medicine. The register is a “living” database and each working day doctors are entered on, removed from, or transferred between the Divisions of the register.
Doctors can leave the register at any time. It is important to note however that a doctor may choose to leave the jurisdiction while still remaining on the register, thereby holding dual registration; therefore it is not possible to accurately provide the exact number of those doctors who have qualified in Ireland and who choose to leave or to remain on the register. Irish qualified doctors will often leave the jurisdiction in order to practise abroad, seeking to attain further specialist training and they will often return back to the Irish health service following a period away.
As the Deputy may be aware, following completion of their medical degree a doctor must complete an intern year in order to be eligible for registration on the General Division, allowing them to practise independently or to continue in structured training. A number of Irish medical schools have international students completing medical degree programmes in Ireland who, on completion of their medical degree may plan to return to their country of origin to undertake an intern year or to continue their training in their own country. Similarly, graduates may decide to complete Foundation Year training in the UK in order to become fully qualified doctors. With these diverse qualification pathways it is difficult to specify the number of doctors who complete their training in Ireland. However, the table below sets out the number of final year students and intern placements for each of the past three years.
|
- |
2019/2020 |
2020/21 |
2021/22 |
|
Final year medical school student |
1,403 |
1,310 |
1,295 |
|
Intern posts |
982* |
854 |
854 |
The Medical Council produces an annual Medical Workforce Intelligence Report which contains detailed analysis of the registration data, focusing on demographics of those retaining and withdrawing from the medical register in Ireland. The most recent report published by the Council covered the reporting period of 2021.
The report identified 982 doctors who voluntarily withdrew from the register, with 306 having graduated from Irish medical schools. It is important to note that this is across all years of graduation, not just the past three years and includes doctors who intend to practise in another country or plan to stop practising altogether (this could include doctors retiring, changing career, moving to academia etc.)
Doctor retention data is being closely monitored by the HSE and shows a high number of doctors returning to commence further post graduate training and/or take up a Consultant post in Ireland. Data from HSE, National Doctors Training and Planning (NDTP) shows that 82% of medical interns who commenced intern training in 2015 subsequently commenced a Basic Specialist Training or General Practice (GP) training programme in subsequent years (2016-2021). Intern year 2015-2020 data shows a trend of medical interns leaving the health service immediately following their intern year, with a substantial number of them returning to the HSE within 2-3 years. In 2021, of the 2016 cohort of doctors who completed specialist training (excluding GP training programme) 68% are employed in Ireland and 32% are abroad or unknown.
It is very common for doctors who have completed postgraduate training to undertake a Fellowship or experience abroad before taking up a consultant post. Indeed, this is often necessary, and to be encouraged, in a country such as Ireland with a relatively small population. Such training is essential to our health service continuing to have access to highly trained specialists at the top of their field. It is important to take this trend into consideration when tracking retention.
1109. Deputy Jackie Cahill asked the Minister for Health if blood tests through one’s GP are covered under the medical card, meaning those in receipt of medical card assistance do not have to pay for such tests; if not, the reason this is the case; if he will consider extending the medical card to cover blood tests; and if he will make a statement on the matter. [35667/23]
View answerUnder the terms of the current GMS contract, GPs are required to provide eligible patients with ''all proper and necessary treatment of a kind usually undertaken by a general practitioner and not requiring special skill or experience of a degree or kind which general practitioners cannot reasonably be expected to possess". Persons who hold a medical card or a GP visit card are not subject to any co-payments or other charges in respect of such services including GP consultations.
The issue of GPs charging GMS patients for phlebotomy services (blood tests) is complex given the numerous reasons and circumstances under which blood tests are taken. Clinical determinations as to whether a blood test should taken to either assist in the diagnosis of illness or the treatment of a condition are made by the GP concerned. There is no provision under the GMS GP contract for persons who hold a medical card or GP visit card to be charged for such blood tests. In addition, blood tests undertaken in the context of services provided under the GP Chronic Disease Management programme are covered by the fees paid to GPs by the HSE for this care.
Where a patient who holds a medical card or GP visit card believes he or she has been incorrectly charged for routine phlebotomy services by his or her GP, or has been charged for a blood test provided under the Chronic Disease Management programme, then that patient should report the matter to their HSE Local Health Office. The local management, upon being notified of potential inappropriate charging of GMS patients, carry out an investigation into each complaint and will, where appropriate, arrange for a refund of charges incorrectly applied by the GP.
Fees charged by GPs outside the terms of the GMS contracts are a matter of private contract between the clinicians and their patients. The HSE does not have any role in relation to such fees.
1110. Deputy Colm Burke asked the Minister for Health what action his Department is taking to appoint a board for the Disabled Drivers Medical Board of Appeal to deal with appeals under the disabled drivers and passengers tax relief scheme; and if he will make a statement on the matter. [35678/23]
View answerI wish to advise the Deputy that this is a matter for the Department of Finance.
1111. Deputy Aindrias Moynihan asked the Minister for Health the level of contact he has had with the domestic waste industry regarding waivers being available to people with health issues and who use incontinence products; and if he will make a statement on the matter. [35700/23]
View answerThe Health Service Executive provides a wide range of medical products and services to eligible persons, including incontinence wear products, following assessment by a relevant health professional. These are available, where prescribed, to those with medical cards or with Long-Term Illness scheme eligibility.
Reimbursement support for incontinence wear products is also provided under the Drug Payment Scheme (DPS), but must be supported by a valid prescription for such products.
The DPS provides for the refund of the amount by which expenditure on approved prescribed medicines or medical and surgical appliances (including incontinence wear) exceeds a named threshold in any calendar month. The DPS is not means tested and is available to anyone ordinarily resident in Ireland. The DPS threshold was reduced on 1 March 2022 to €80 per month. The DPS significantly reduces the cost burden for those who are not eligible for a medical card or Long-Term Illness scheme card but who incur ongoing medical expenditure.
As the Department of the Environment, Climate and Communications holds responsibility for the administration of waste disposal charges, queries in that regard should be directed to that Department.
1112. Deputy Aindrias Moynihan asked the Minister for Health the current level of mental health supports available for persons with eating disorders in the County Cork; and if he will make a statement on the matter. [35701/23]
View answerAs this is a service matter, I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.
1113. Deputy Aindrias Moynihan asked the Minister for Health what measures are being taken to address the shortage of GPs for County Cork; how many individuals are waitlisted for GP services currently in County Cork; and if he will make a statement on the matter. [35702/23]
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 2,545 GPs contracted to provide services under the GMS Scheme.
As GPs are private practitioners, the scheduling of consultations is a matter for each individual practice. The HSE does not maintain waiting lists for GP services. Where scheduling is required, GPs prioritise appointments based on urgency and health need.
The Government is aware of the workforce issues currently facing general practice, including the limited access to GP services in certain areas, and is working to ensure 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%.
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.
As recently announced, agreement has been reached with the IMO to extend eligibility for GP visit cards to people who earn up to the median household income and to children aged 6 & 7. Approximately 500,000 additional persons are expected to become eligible for free GP care under this expansion, the largest expansion of access to GP care without charges in the history of the State. This new GP agreement includes additional capacity supports to enable the expansion and retention of staffing within general practice. It also includes additional supports for GP Out of Hours services.
In addition, the number of doctors entering GP training has been increased significantly in recent years, rising from 193 in 2019 to 287 this year, with 350 places now planned for next year. Furthermore, the joint HSE and ICGP programme to bring up to 100 non-EU GPs to Ireland in 2023 will help to quickly improve access to GP services, particularly in areas with limited access. The programme is on target to bring 100 non-EU GPs to Ireland this year, and it is planned to bring to Ireland up to 250 more non-EU GPs by the end of 2024.
Lastly, my Department and the HSE have commenced a strategic review of GP services. The review, with input from key stakeholders, will examine the broad range of issues affecting general practice, including issues related to GP capacity, and will set out the measures necessary to deliver a more sustainable general practice into the future.
1114. Deputy Michael Healy-Rae asked the Minister for Health if he will review the case of a person (details supplied); and if he will make a statement on the matter. [35703/23]
View answerAs this is a service matter, I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.
1115. Deputy Michael Healy-Rae asked the Minister for Health if he will reconsider the closing down of congregated settings (details supplied); and if he will make a statement on the matter. [35705/23]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
1116. Deputy Paul Kehoe asked the Minister for Health if he will consider reopening a health centre (details supplied); and if he will make a statement on the matter. [35729/23]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
1117. Deputy Dara Calleary asked the Minister for Health if there are plans to add a condition (details supplied) to the long-term illness scheme. [35732/23]
View answerThe Long-Term Illness (LTI) Scheme was established under Section 59(3) of the Health Act 1970 (as amended).
Regulations were made in 1971, 1973 and 1975, prescribing 16 illnesses covered by the Scheme. These are: acute leukaemia; mental handicap; cerebral palsy; mental illness (in a person under 16); cystic fibrosis; multiple sclerosis; diabetes insipidus; muscular dystrophies; diabetes mellitus; parkinsonism; epilepsy; phenylketonuria; haemophilia; spina bifida; hydrocephalus; and conditions arising from the use of Thalidomide.
Under the LTI Scheme, patients receive drugs, medicines, and medical and surgical appliances directly related to the treatment of their illness, free of charge.
While there are currently no plans to extend the list of conditions, it is important to remember that the LTI Scheme exists within a wider eligibility framework.
This Government has put a significant focus on improving access to and the affordability of healthcare services, advancing substantial policy, legislation and investment to deliver expanded eligibility.
In 2022, a range of measures were delivered including the abolition of public inpatient charges for children, reductions in the Drug Payment Scheme threshold to €80 per month, and the introduction of free contraception for women aged 17-25.
The significant investment in Budget 2023 will facilitate better access to affordable, high-quality healthcare for people at a time when the cost-of-living crisis is impacting on everyone. In 2023 this includes:
- an expansion of GP care without charges to children aged under 8, and to people earning no more than the median household income,
- the abolition of all public in-patient hospital charges for adults since 17 April 2023,
an extension of free contraception to 26-year-old women since 1 Jan 2023, and further extension to 27-30 years old women from 1 September 2023.
These measures continue to create a health and social care service that offers affordable access to quality healthcare.
People who cannot, without undue hardship, arrange for the provision of medical services for themselves and their dependants may be eligible for a medical card under the General Medical Services (GMS) Scheme. In accordance with the provisions of the Health Act 1970 (as amended), eligibility for a medical card is determined by the HSE. Medical card eligibility is primarily based on an assessment of means and is not granted on the basis of any particular condition.
In certain circumstances the HSE may exercise discretion and grant a medical card, even though an applicant exceeds the income guidelines, where he or she faces difficult financial circumstances, such as extra costs arising from illness. In circumstances where an applicant is still over the income limit for a medical card, they are then assessed for a GP visit card, which entitles the applicant to GP visits without charge.
Under the Drug 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.
Individuals may also be entitled to claim tax relief on the cost of their medical expenses, including medicines prescribed by a doctor, dentist, or consultant. Relief is at the standard tax rate of 20%.
1118. Deputy Danny Healy-Rae asked the Minister for Health if urgent consideration will be given to a matter regarding dispensing fees for pharmacists (details supplied); and if he will make a statement on the matter. [35752/23]
View answerThe regulations governing the pharmacy fee structure are set out in the Public Service Pay and Pensions Act 2017 (No. 34 of 2017) and in S.I. No. 639 of 2019, the Public Service Pay and Pensions Act 2017 (Payments to Community Pharmacy Contractors) Regulations 2019, which put the current fee structure in place, with effect from 1 January 2020.
Under Section 42(14) of the Public Service Pay and Pensions Act 2017 the pharmacy fee structure must be reviewed every third year after 2020. My Department is currently carrying out a comprehensive review. Department officials held a meeting with the Irish Pharmacy Union on 20th June 2023 and a further meeting is scheduled for 26th July 2023.
I believe that there is a real opportunity to work collaboratively with community pharmacists, and with other healthcare providers, to make a significant difference to patient outcomes. Of course, any publicly funded pharmacy service expansion should address unmet public healthcare needs, improve access to existing public health services, and provide better value for money.
1119. Deputy Seán Canney asked the Minister for Health the number of neo-natal deaths that have been registered which included premature delivery or termination of pregnancy as a cause of death and in cases in which a condition was present affecting the foetus that was likely to lead to the death of the foetus either before or within 28 days of birth. [35758/23]
View answerAs the Deputy's question relates to a service matter, I have referred it to the HSE for direct reply.
1120. Deputy Willie O'Dea asked the Minister for Health the number of GP clinics in the country to date in 2023; and if he will make a statement on the matter. [35759/23]
View answerGPs are private practitioners. Most GPs hold a GMS contract with the HSE to provide health services to medical card and GP visit card holders without charge. Under the GMS contract, contracted GPs are to make themselves routinely available for consultation by eligible persons at their approved surgery for a total of 40 hours each week on five days or more in the week. As GPs are private practitioners, data is not held on the actual number of clinical sessions provided by GPs.
As of July, 2,545 GPs hold a GMS contract and a further 571 GPs hold some other contract with the HSE for the provision of health services such as services under the Primary Childhood Immunisation Scheme or National Cancer Screening Service. GMS contracts are held between the HSE and individual GPs rather than with GP practices.
1121. Deputy Willie O'Dea asked the Minister for Health the number of family planning centres in the country to date in 2023; and if he will make a statement on the matter. [35760/23]
View answerThe free contraception scheme, which covers prescription contraception, was introduced in September 2022 for women ordinarily resident in Ireland and aged between 17-25. The scheme was extended to women aged 26 from 1 January 2023.
The scheme covers the cost of consultations with GPs and family planning centres and prescriptions for the wide range of contraceptive options available on the HSE Re-Imbursement List, including long-acting reversible contraception (LARCs: injections, intra-uterine devices and systems (coils) and implants) and emergency contraception in addition to the contraceptive Pill, patch and ring. LARC fittings, removals, injections and check-ups are also free of charge under the scheme.
Almost 2,400 GPs and other primary care providers, and almost 1,900 pharmacies, have signed up to provide services and products under the scheme to date. Approximately €32m was allocated to support the scheme in 2023. The scheme will be expanded further, from September 1st, 2023, to include women aged 30 and under.
The HSE manages the contracts with GPs, family planning centres, student health centres and other primary care providers contracted under the free contraception scheme and any other relevant State funded services.
The HSE are therefore best placed to provide information with regard to the numbers of specialist family planning centres involved in State funded service provision. It should be noted that, as family planning centres are private contractors; the HSE will be able to provide information on the number of family planning centres contracted to provide State funded services only.
As this is a service matter, I have asked the Health Service Executive to respond to the deputy directly, as soon as possible.
1122. Deputy Richard Boyd Barrett asked the Minister for Health if he is aware that a fully registered and regulated charity is fundraising to provide a paediatric MRI scanner to the new children's hospital in Dublin; the reason a charity would need to provide the scanner, given the vast amount of tax payers’ money that is been spent on the hospital; and if he will make a statement on the matter. [35762/23]
View answerThe significant undertaking which is the children’s hospital project and programme shows the commitment of the Government to develop paediatric services for children and young people.
The new children’s hospital building will bring acute paediatric hospital services and specialities in Children’s Health Ireland under the one roof for the first time, leading to improved clinical outcomes and a better experience for children, young people, and their families. This is a much needed and much deserved investment in our children and young people.
Children’s Health Ireland has advised that individuals and charitable groups from time to time decide to raise funds for children in hospital in Ireland, and this motivation can be based on altruism, a good experience in services, or a wish to improve access. Children’s Health Ireland engages with such individuals and groups to establish how the funds raised can be applied to support sick children in line with donors wishes.
Children’s Health Ireland has further advised that philanthropy features in many hospitals internationally and support from philanthropy can add value to services.
1123. Deputy Patrick Costello asked the Minister for Health if his Department has received the submission from a group (details supplied); his views on the report; if he will meet the group in question; and if he will make a statement on the matter. [35767/23]
View answerThis Government remains committed to the development of all aspects of mental health services nationally, including those for children and young people. The total allocation for mental health services in 2023 is over €1.2 billion, another record budget for mental health services. A key objective is to improve access and address CAMHS waiting lists, in light of increasing demand and case complexity.
Around €137 million is provided to Child and Adolescent Mental Health Services (CAMHS) annually. In addition, over €90 million has been provided to community-based mental health organisations this year, with a significant proportion of this dedicated to supporting child and young people.
The Programme for Government commits to improve all aspects of CAMHS in line with Sharing the Vision, Connecting for Life, and the annual HSE Service Plans. In addition, I recently completed a series of high-level roundtables bringing together the Department of Health, HSE, and other key stakeholders in youth mental health to drive improvement in CAMHS with a focus on executive leadership, clinical expertise and service provision.
The 35 recommendations arising from the Maskey report reviewing South Kerry CAMHS care will help improve all aspects of CAMHS care nationally. The 35 recommendations led to 63 actions, 19 of which (national and local) have been implemented, with others underway. To provide assurance to those who use CAMHS, the HSE has commissioned independent national audits in relation to: prescribing practice, compliance with Operational Guidelines, and research into service user experiences of CAMHS.
I await the outcomes of all audits underway on CAMHS nationally, including the final report of the independent review by the Mental Health Commission on CAMHS nationally. This will help to help inform any next steps necessary regarding CAMHS.
Unfortunately, I am not in a position to meet with this Group over the forseeable future, but I will keep the matter under review. However, I have received the report referred to in the Deputy’s question and I have asked officials in the Department to arrange a meeting with the Group at an early date.
1124. Deputy Joan Collins asked the Minister for Health the options that are available to a person aged 15 years who has been waiting since January 2019 for orthodontic treatment; if they qualify for treatment under the National Treatment Purchase Fund or the Cross-Border Directive; and if he will make a statement on the matter. [35778/23]
View answerThe Northern Ireland Planned Healthcare Scheme, operational from 1 January 2021 for 12 months on an administrative basis, enables persons resident in the State to access and be reimbursed for private healthcare, including orthodontic care, in Northern Ireland by the HSE, provided such healthcare is publicly available within Ireland. It should be noted that the scheme operates on parameters similar to the EU Cross Border Directive. Patients are advised to contact the HSE Cross Border Directive office directly for further information on individual applications and types of treatment available under the NI Planned Healthcare Scheme.
Patients also continue to have access to health services under the EU Cross Border Directive Scheme in all other remaining EU/EEA countries. In the context of the Covid-19 pandemic, persons seeking to utilise these schemes should review and adhere to the public health guidance and restrictions in place at any point in time.
The National Treatment Purchase Fund (NTPF) works with public hospitals, as opposed to with patients directly, to offer and provide the funding for treatment to clinically suitable long waiting patients who are on an inpatient/day case waiting list for surgery, having been referred on to such a list following clinical assessment by a consultant/specialist at an outpatient clinic.
The NTPF advise that they do provide treatment for patients who are awaiting procedures under the category of 'Dental/Maxilla-Facial Surgery'. The NTPF further advise that children can avail of treatment through the NTPF, including for dental procedures. The key criteria of the NTPF is the prioritisation of the longest waiting patients first. While the NTPF identifies patients eligible for NTPF treatment, it is solely on the basis of their time spent on the Inpatient/Daycase Waiting List. The clinical suitability of the patient to avail of NTPF funded treatment is determined by the public hospital.
Where resources are available the HSE, through national or local initiatives, outsources routine orthodontic care to reduce waiting times. Under the most recent procurement initiative approximately 2,000 patients were transferred to orthodontists in the private sector between 2016 and 2020. A successor arrangement is currently being prepared and the HSE hopes to place the first patients during the summer months.
