Tuesday, 25 Jul 2023

Written Answers Nos. 1390-1410

Hospital Procedures

Questions (1390)

Róisín Shortall

Question:

1390. Deputy Róisín Shortall asked the Minister for Health the number of vaginal mesh removals carried out in each of the years 2020, 2021 and 2022, in tabular form; the number of retropubic implants (TVT) fully removed; the number of transobturator implants (TVTO) fully removed; the number of pelvic prolapse meshes (POP) fully removed; the number of other meshes fully removed with a description of the type of mesh (details supplied); and if he will make a statement on the matter. [37043/23]

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 to the Deputy directly, as soon as possible.

Assisted Human Reproduction

Questions (1391, 1392)

Catherine Connolly

Question:

1391. Deputy Catherine Connolly asked the Minister for Health the status of the roll-out of publicly funded IVF in CH02; the timeline for when publicly funded IVF will be available in CH02; to clarify the eligibility criteria whereby persons can avail of publicly funded IVF; and if he will make a statement on the matter. [37046/23]

Catherine Connolly

Question:

1392. Deputy Catherine Connolly asked the Minister for Health the status of the roll-out, by CHO area, of the Model of Care for Fertility; the timeline for when the model will be completely rolled-out; and if he will make a statement on the matter. [37047/23]

Written answers

Minister for Health

I propose to take Questions Nos. 1391 and 1392 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) and ICSI (intra-cytoplasmic sperm injections), 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 five Regional Fertility Hubs currently fully operational, including in University Hospital Galway. The sixth and final Hub, located in Nenagh, has commenced specialist nurse-provided fertility clinics in recent weeks, with a newly appointed consultant in reproductive medicine due to commence in September.

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 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 is near finalisation and I am hopeful to be in a position to provide more specific details in the coming days.

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.

Question No. 1392 answered with Question No. 1391.

Health Services

Questions (1393)

Matt Carthy

Question:

1393. Deputy Matt Carthy asked the Minister for Health the reason a person (details supplied) has not received OT support since January 2023; if he will ensure that this situation is rectified as a matter of urgency, considering the impact that the removal of services has had on the person and their family; and if he will make a statement on the matter. [37060/23]

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 to the Deputy directly, as soon as possible.

Health Services Waiting Lists

Questions (1394)

Ivana Bacik

Question:

1394. Deputy Ivana Bacik asked the Minister for Health the number of people who are waiting more than sixty days for an urgent referral for cancer diagnosis. [37070/23]

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. 

Mental Health Services

Questions (1395)

Ivana Bacik

Question:

1395. Deputy Ivana Bacik asked the Minister for Health the number of minors who have been placed on adult psychiatric wards. [37071/23]

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.

Health Services Staff

Questions (1396)

Duncan Smith

Question:

1396. Deputy Duncan Smith asked the Minister for Health the projected cost of providing additional funding to Section 39 organisations to provide pay increases in line with the current public service pay deal; to provide a breakdown by organisation; and if he will make a statement on the matter. [37082/23]

Written answers

Minister of State at the Department of Health

I appreciate that the Deputy is seeking clarity on the cost of implementing the pay parity claim, however, as this is a live Industrial Relations matter, it would be inappropriate to comment any further at this point.

Health Services Staff

Questions (1397)

Duncan Smith

Question:

1397. Deputy Duncan Smith asked the Minister for Health the amount spent on agency staff in 2022 and to date in 2023 across the health service, broken down by staffing type and to whom the payments were made; if he will provide a breakdown for the amount spent on nursing agency staff in 2022 and to date in 2023; his plans to address this; and if he will make a statement on the matter. [37083/23]

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 to the Deputy directly, as soon as possible.

Departmental Schemes

Questions (1398)

Duncan Smith

Question:

1398. Deputy Duncan Smith asked the Minister for Health the estimated cost of reducing the drugs payment scheme threshold to €50; and if he will make a statement on the matter. [37084/23]

Written answers

Minister for Health

It is estimated that the full year cost of reducing the Drugs Payment Scheme (DPS) threshold from the current threshold of €80 per month to €50 per month would be €47.5m at a minimum.

This data is based on the claiming month of May 2023 (c. 132,000 claimants), is annualized to determine the full year cost, and does not include the cost for those who are currently sub-threshold but who may become eligible for the Scheme were the threshold reduced. 

It is therefore likely that the full year cost will exceed this minimum and fall somewhere (depending on the number of additional claimants) between €47.5m and €63.7m per annum.

Health Strategies

Questions (1399)

Duncan Smith

Question:

1399. Deputy Duncan Smith asked the Minister for Health the projected full-year cost of expanding the free contraception scheme to all women; and if he will make a statement on the matter. [37085/23]

Written answers

Minister of State at the Department of Health

The free contraception scheme for women aged 17 -25 was launched on 14th September, 2022, and expanded to include 26-year-olds on January 1st, 2023. The scheme is currently open to women aged 17-26 ordinarily resident in Ireland, and will be expanded to women aged 27-30 inclusive on September 1st, 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, intrauterine 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 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, including scheduled expansions. Expansion to girls age 16 was also allocated funding in 2023, however, this is subject to consultation, ongoing legal consideration and, should pending legal advice permit, legislative amendment.   

Good financial practice recommends that demand led schemes are introduced on a pilot basis, both to ensure that real world costs are within allocated budgets and that the new scheme works according to intended parameters – it is easier to complete the operational streamlining of new programmes when these are working with subsets of the population. 

As per the recommendations of the Report of the Working Group on Access to Contraception (which is available on the Department’s website), it was decided to commence the scheme with younger age cohorts, as they are least likely to be financially independent and many are still engaged in full time education.   

The Report of the Working Group on Access to Contraception also highlighted that there may have been potential issues with sufficient capacity in primary care to fit LARCs, should the scheme have been introduced to all cohorts at once. However, the ICGP are being funded since 2022 to increase the number of LARC trained GPs. This training scheme is operational and is working to increase LARC fitting capacity currently.

Costings supporting the scheme have been published and are available through the Report of the Working Group on Access to Contraception, which is available on the Department’s website. The fees reimbursable to service providers under the scheme are also listed in S.I. No.451 of 2022, which is available on www.irishstatutebook.ie . Any decision relating to further expansion of the free contraception scheme for women will be a matter for the Estimates process in advance of Budget 2024.

Health Strategies

Questions (1400)

Duncan Smith

Question:

1400. Deputy Duncan Smith asked the Minister for Health the estimated cost in 2024 of reducing prescription charges to €1 per item with a cap of €10 for all, or to 50 cent per item with a cap of €5 for all; the overall cost of abolishing the charges; and if he will make a statement on the matter. [37086/23]

Written answers

Minister for Health

The Health Service Executive (HSE) has responsibility for the administration of the community drug schemes, including the General Medical Services Scheme. Therefore, this matter has been referred to the HSE for attention and direct reply to the Deputy, as soon as possible.

Emergency Departments

Questions (1401)

Duncan Smith

Question:

1401. Deputy Duncan Smith asked the Minister for Health the estimated cost in 2024 of reducing emergency hospital charges to either €50 or abolishing it; the cost of removing the €75 charge for an injury unit, in tabular form; and if he will make a statement on the matter. [37087/23]

Written answers

Minister for Health (Deputy Stephen Donnelly)

Patient charges are a key element of the overall funding envelope of the Irish health system and are considered when agreeing the Annual Estimates and the subsequent preparation of the HSE’s annual National Service Plan.  

Patients who attend at public hospitals are, depending on their eligibility, and subject to certain exemptions, liable to statutory charges. These are levied under the provisions of the 1970 Health Act. The charges are €100 for an Emergency Department attendance and €75 for Injury Unit attendance. The HSE has a statutory obligation to levy and collect these charges and Hospitals have the discretion to operate payment plans where appropriate.

Emergency Department (ED) charges and Injury Unit are recorded by the HSE as Out-Patient Income. In the last reported year of 2021 the HSE reported Hospital Out-Patient Income of €22.4m. 

-	2021 €m
Outpatient Charges (incl. ED & injury Unit)	22.4

Medical Cards

Questions (1402)

Duncan Smith

Question:

1402. Deputy Duncan Smith asked the Minister for Health the estimated cost of providing in 2024 medical cards to all those diagnosed with cancer; and if he will make a statement on the matter. [37088/23]

Written answers

Minister of State at the Department of Health

Under the Health Act 1970, eligibility for a medical card is based primarily on means. The Act obliges the HSE to assess whether a person is unable, without undue hardship, to arrange general practitioner services for himself or herself and his or her family, having regard to his or her overall financial position and reasonable expenditure.

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.  

Furthermore, the HSE also has a system in place for the efficient provision of medical cards in response to emergency situations i.e., in circumstances where persons are in need of urgent ongoing medical care or are receiving end of life care.  In these cases, a medical card is issued within 24 hours of receipt of the required patient details and completed medical report by a healthcare professional.  Additionally, patients who have been certified by their treating Consultant as having  a prognosis of 24 months or less are also now eligible for a medical card without a means assessment.

Finally, it should be noted 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 within the last five years.

With regard to the estimated cost of providing medical cards in the manner sought, this information is not readily available, and it is therefore not possible to provide an estimate of the cost of the proposal.

Medical Cards

Questions (1403)

Duncan Smith

Question:

1403. Deputy Duncan Smith asked the Minister for Health the estimated cost of increasing medical card income limits by 5%, 10% or 20%, and in each case, the projected additional number of cards that would be issued; and if he will make a statement on the matter. [37089/23]

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. 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 €1,050 for a couple. This increase ensures that a greater proportion of those aged 70 and over now qualify for a medical card. Furthermore, the Deputy may be aware that, since 2015, every individual aged 70 and over has automatic eligibility for a GP visit card. 

As provided for in Budget 2023, eligibility for GP visit cards will be extended to people who earn up to the median household income and to all children aged 6 & 7. Approximately 500,000 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 extension of GP visit cards to children aged 6 & 7 will commence on 11 August.  The extension of cards to those who earn the median household income or less will commence on 11 September and will be completed in two phases with the second phase commencing on 13 November. 

Modelling scenarios normally used to determine estimated cost increases for medical card eligibility will likely be affected by these planned changes. Per request by the Deputy, it will be necessary for there to be opportunity for the extension of eligibility for GP services to commence and become operationalised before being able to accurately reflect the impact of this significant change in eligibility on estimated costs for amendments to medical card income thresholds more generally.

Home Help Service

Questions (1404)

Duncan Smith

Question:

1404. Deputy Duncan Smith asked the Minister for Health the funding provided for the home support service in 2023; the number of home care packages funded; the projected additional cost of providing a home care package to every identified case in 2023; and if he will make a statement on the matter. [37090/23]

Written answers

Minister of State at the Department of Health

As these are operational matters, I have asked the Health Service Executive to respond to the deputy directly, as soon as possible.

Home Help Service

Questions (1405)

Duncan Smith

Question:

1405. Deputy Duncan Smith asked the Minister for Health the number of home care and home help hours funded in 2022, and 2023, respectively; the amount not utilised due to staffing shortages; and if he will make a statement on the matter. [37091/23]

Written answers

Minister of State at the Department of Health

As this is an operational matter, I have asked the Health Service Executive to respond to the deputy directly, as soon as possible.

Vaccination Programme

Questions (1406)

Duncan Smith

Question:

1406. Deputy Duncan Smith asked the Minister for Health the cost of the flu vaccine programme in 2022 and 2023, respectively; how many doses are expected to be provided in 2023 and 2024; how many doses the State ordered; the estimated cost to provide the flu vaccine free to all; and if he will make a statement on the matter. [37093/23]

Written answers

Minister of State at the Department of Health

As this is an operational matter, I have asked the Health Service Executive to respond to the deputy directly, as soon as possible.

General Practitioner Services

Questions (1407)

Duncan Smith

Question:

1407. Deputy Duncan Smith asked the Minister for Health the estimated cost of providing free GP care to all children under 18 years on the basis of the fees provided for the expansion of the current scheme to six- and seven-year-olds; and if he will make a statement on the matter. [37094/23]

Written answers

Minister of State at the Department of Health

At present all children under 6 years of age are eligible for a GP visit card. This is to be extended to all children under 8 years of age from the 11th of August as per the recently agreed GP Agreement 2023. The Agreement provides, amongst other things, for a new capitation rate for participating GPs in respect of children aged 6 and 7.

Based on 2022 average GP visit card costs, adjusted as per the new capitation rate for children aged 6 and 7, and the number of persons aged 8 to 17 years (existing GMS card holders and estimated non-holders), the additional cost of providing GP care without charges to all children under 18 years of age (i.e. the cost of providing GP care without charges to all children aged 8 to 17 inclusive) is simplistically estimated to be €96 million.

It should be noted that the new capitation rate in respect of children aged 6 and 7 is less than the current rate for female patients aged 16 years or more and less than 45 years. In addition, the estimation does not account for any increased cost that may arise in respect of existing practice supports under the GMS scheme due to the resultant increases in GPs' GMS panel size. Furthermore, no new additional practice and service supports, such as those provided under the GP Agreement 2023, are considered in the above calculation.

Consultations with the IMO, representing GPs, would need to be held prior to any further expansion of GP visit card eligibility and would include discussions on the scope of services to be provided, the resourcing required to provide those services, and the rate of fees and other supports payable to GPs for providing services.

As it is not possible to predict the services to be provided as agreed as a result of such discussions and the fees for same, the actual cost of extending GP care without fees to any further cohorts cannot be accurately extrapolated from the current figures.

Vaccination Programme

Questions (1408)

Duncan Smith

Question:

1408. Deputy Duncan Smith asked the Minister for Health the estimated cost of providing the HPV vaccine for free to adults who have not received it but want to access it through their GP; and if he will make a statement on the matter. [37095/23]

Written answers

Minister of State at the Department of Health

As this is an operational matter, I have asked the Health Service Executive to respond to the deputy directly, as soon as possible.

Question No. 1409 answered with Question No. 1232.

Hospital Facilities

Questions (1410)

Duncan Smith

Question:

1410. Deputy Duncan Smith asked the Minister for Health the current number of ICU beds in place; how many are currently funded; how many additional ICU beds will be provided in 2023 and are planned for 2024; the all-in cost for a new ICU bed, support services and staffing; the projected cost for 50 additional ICU beds; and if he will make a statement on the matter. [37097/23]

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.