Wednesday, 20 Sep 2023

Written Answers Nos. 945-964

Medical Cards

Questions (945)

Violet-Anne Wynne

Question:

945. Deputy Violet-Anne Wynne asked the Minister for Health if he will adjust medical card provision for persons (details supplied); and if he will make a statement on the matter. [40039/23]

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 efficient provision of medical cards in response to emergency situations i.e., where persons are in need of urgent ongoing medical care or when a patient is receiving end of life treatment. 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. 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.

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.

Hospital Overcrowding

Questions (946)

Violet-Anne Wynne

Question:

946. Deputy Violet-Anne Wynne asked the Minister for Health if he will implement a crisis management plan at a hospital (details supplied), in view of recent significant overcrowding; and if he will make a statement on the matter. [40040/23]

Written answers

Minister for Health

As this is a service matter, I have asked the HSE to respond to the Deputy directly with the requested information.

Health Service Executive

Questions (947, 948)

Violet-Anne Wynne

Question:

947. Deputy Violet-Anne Wynne asked the Minister for Health if he will publish the HSE winter plan for this year as soon as possible; and if he will make a statement on the matter. [40041/23]

Violet-Anne Wynne

Question:

948. Deputy Violet-Anne Wynne asked the Minister for Health when he will publish the HSE winter plan for this year; and if he will make a statement on the matter. [40042/23]

Written answers

Minister for Health

I propose to take Questions Nos. 947 and 948 together.

Urgent and Emergency Care pressures are no longer just experienced during winter periods. Prolonged levels of high presentations and congestion now occur throughout the year. While significant investment has been driven through Winter Planning and National Service Plans over the past three years, a new approach to Urgent and Emergency Care (UEC) planning is now required in response the changing demands.

This approach is twofold:

• The delivery of an Urgent and Emergency Care Operational Plan for 2023, which was signed off by Government at the end of July; and

• The delivery of a 3-year multi-annual UEC Strategy, which is expected to be submitted to Government in the Autumn.

Surge periods of exceptionally high ED activity are anticipated for the remainder of 2023. The Plan contains surge measures, which were informed by the After-Action Review of the Winter Plan 2022/23. The UEC Operational Plan 2023 has been published on the HSE website.

The UEC Operational Plan 2023 will lead into year one of the multi-annual UEC Strategy and will align with the governance structure of the overarching multi-annual UEC Strategy.

Question No. 948 answered with Question No. 947.

Hospital Services

Questions (949)

Violet-Anne Wynne

Question:

949. Deputy Violet-Anne Wynne asked the Minister for Health who is the final decision maker with respect to the reinstatement of accident and emergency services at a hospital (details supplied); and if he will make a statement on the matter. [40045/23]

Written answers

Minister for Health

In 2013, the Government approved the Smaller Hospitals Framework, which defined the role of smaller hospitals and outlined the need for both smaller and larger hospitals to operate within Hospital Groups. The Framework identified the activities that can be performed in smaller Model 2 hospitals, in a safe and sustainable manner. In developing our smaller hospitals, the first and overriding priority is the safety of patients.

This Framework provided a stronger role for smaller hospitals, like Ennis Hospital, in delivering a higher volume of less complex care in many cases closer to patients’ homes. It also ensures that patients who require true emergency or complex planned care are managed safely in a larger hospital environment.

Regarding hospitals in the University of Limerick Hospital Group (ULHG), in April 2009, a process of reconfiguration commenced with the closure of the 24-7 emergency departments in Ennis and Nenagh. These emergency departments were replaced with Medical Assessment Units (MAUs) for GP referrals; and by local injury units/urgent care centres for self-referrals and operating 12 hours a day, seven days a week. These changes were supported by an Emergency Care Network, which had been set up in the region and led by Consultants in Emergency Medicine. These consultants, while based in University Hospital Limerick (UHL), have clinical responsibility for the Injury Units in Ennis, Nenagh and St John's. Additional Consultants in Emergency Medicine were recruited to support these changes in addition to Advanced Nurse Practitioners for the Injury Units in the smaller hospitals and for the Emergency Department (ED) in UHL.

Within the ULHG, there are two Model 2 Hospitals, Ennis and Nenagh Hospitals. St John's Hospital is classified as a Model 2S Hospital, i.e. St. John's can carry out intermediate surgery, which requires in-patient stay and accommodation in addition to day case surgery. These hospitals play a pivotal role in the delivery of high-quality patient care within the region.

The Model 2 hospitals accept transfers of appropriate patients from UHL daily. These patients can either be stepped down from an inpatient ward in UHL or they may, where a clinician has decided it is appropriate, transfer to Ennis, Nenagh or St John’s directly from the ED in UHL

The introduction of the Medical Assessment Unit (MAU) pathway development in Ennis Hospital and the Mid-West region 112/999 patients commenced on January 9th 2023. It allows patients that meet the agreed clinical criteria to be treated in a Model 2 hospital. This pathway will result in patients receiving medical treatment in a hospital closer to their home, will reduce patient presentations to EDs and will release ambulances more quickly to respond to other emergency calls. The MAU in Ennis Hospital treats patients referred by GPs, ShannonDoc, and now National Ambulance Service paramedics. 112/999 patients that do not meet these clinical criteria will continue to be transported to EDs for assessment and treatment.

UL Hospitals Group has been approved for funding of €5.2m by the HSE’s National Acute Division for our MAUs. This funding has secured the already extended weekend service at Ennis MAU and allows for St John’s and Nenagh MAU to open seven days per week.

I have expressed concern about overcrowding in the ED in Limerick and acknowledge the distress caused to patients, their families, and frontline staff working in very challenging conditions in emergency departments in UHL and throughout the country. The HSE’s Performance Management and Improvement Unit (PMIU) led an intensive engagement with UHL team members throughout the summer in response to my concerns about the hospital and the findings of the HIQA report following an unannounced inspection of the ED in UHL in March. The engagement supported the hospital and community services in driving a programme of work to respond more effectively to the pressures at the hospital. UHL continues to engage with the support team, working jointly with HSE Mid-West Community Healthcare to respond to pressures faced at UHL.

There has also been significant investment in infrastructure in UHL in recent times. For example, in October 2022, I broke ground on the new 96-bed inpatient block project at University Hospital Limerick. This project represents a total capital investment of just over €90 million, and will deliver a 4-storey, 96 single bed acute inpatient ward block and will go some way toward addressing capacity issues in the region. In 2021, a new 60-bed modular ward block opened. This follows the completion of two separate rapid-build projects, constructed in response to the Covid-19 emergency, which provided an additional 38 inpatient beds on site at UHL. The new injury unit in Ennis for treatment of breaks, sprains, and minor burns was opened on 29th June 2023.

There are no plans at this time to reopen the accident and emergency unit at Ennis General Hospital, but I would like to assure the Deputy that my Department continues to work closely with the HSE to ensure UHL is fully supported and that the necessary improvements to address capacity issues are actioned in a timely manner.

Medical Cards

Questions (950)

Fergus O'Dowd

Question:

950. Deputy Fergus O'Dowd asked the Minister for Health if there is any consideration being given to the automatic provision of medical cards to people with a spinal cord injury based on certified medical needs, rather than means; and if he will make a statement on the matter. [40053/23]

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 efficient provision of medical cards in response to emergency situations i.e., where persons are in need of urgent ongoing medical care or when a patient is receiving end of life treatment. 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. 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.

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.

Medical Cards

Questions (951)

Fergus O'Dowd

Question:

951. Deputy Fergus O'Dowd asked the Minister for Health to outline if there is any consideration being given to extending the review cycle for medical card holders with a spinal cord injury to ten years; and if he will make a statement on the matter. [40054/23]

Written answers

Minister for Health

In accordance with the provisions of the Health Act 1970 (as amended), eligibility for a medical card is determined by the HSE. 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.In that regard the HSE is also required to undertake periodic reviews of eligibility in order to ensure that a person continues to meet the qualifying criteria required to continue holding eligibility. Where any medical or GP visit card holder has a review process initiated, it should be noted that he/she will continue to retain their eligibility for the duration of the review process.Every effort is also made by the HSE, within the framework of the legislation, to provide an eligibility assessment process that is responsive and sensitive to people’s needs, in particular, to take full account of the difficult circumstances in the case of applicants who may be in excess of the income guidelines. Social and medical issues are also considered when determining whether undue hardship exists for an individual accessing general practitioner or other medical services and to that end, the HSE may exercise discretion and grant a medical card where an applicant exceeds his or her income threshold.

Health Services Waiting Lists

Questions (952)

Michael Healy-Rae

Question:

952. Deputy Michael Healy-Rae asked the Minister for Health to expedite an appointment (details supplied); and if he will make a statement on the matter. [40057/23]

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.

Legislative Programme

Questions (953)

Róisín Shortall

Question:

953. Deputy Róisín Shortall asked the Minister for Health the status of new legislation to replace the Dentists Act 1985; the timeline he is working towards; the reason for the delay in progressing this legislation; and if he will make a statement on the matter. [40065/23]

Written answers

Minister for Health

The practice of dentistry is underpinned by a range of legislation, of which the Dentists Act 1985 is only one. Currently five separate state and regulatory agencies (Health Information and Quality Authority, Health Service Executive, Health and Safety Authority, Environmental Protection Agency and Local Authorities) have a regulatory interest and oversight of dental practices, primarily for the protection of the public.

While I am aware that the Dentists Act 1985 needs to be updated to align with other healthcare profession regulatory legislation, the Act was amended by the Regulated Professions (Health and Social Care) (Amendment) Act 2020, which was signed into law in October 2020.

In the context of the wider need to update dental legislation, the Department of Health is committed to reviewing the Dentists Act 1985. The protection of the public and ensuring high oral healthcare standards will continue to be the central focus of this work. The review and updating of the legislation also, necessarily, is directly related to the wider implementation of the National Oral Health Policy, which envisages a fundamental reform of oral health services. As such, any new legislation will also be informed by this work. Additional resources have been allocated to commence this work to further strengthen the regulation of dentists in Ireland. The Department is currently undertaking preparatory scoping and planning work to support the review. As part of this preparatory scoping work, the Department is considering the necessary timelines required to deliver a robust, evidence based modern regulatory framework with due consideration to the policy alignment referenced above.

Health Services Staff

Questions (954)

Róisín Shortall

Question:

954. Deputy Róisín Shortall asked the Minister for Health further to Parliamentary Questions Nos. 403 and 404 of 8 February 2023 and No. 481 of 3 May 2023, if he is aware of the position of the HSE's Heads of Psychology Services Ireland, HPSI, and the Psychological Society of Ireland, PSI, on the use of certain titles, given that these titles are not recognised as being currently in use by the HSE's national HR office; if not, if he will engage with the HPSI and the PSI on this matter to establish how these titles came to be in use; if these individual managers should refrain from using these titles as they imply a wider remit or higher level of authority than the title that is in use for such managers; and if he will make a statement on the matter. [40067/23]

Written answers

Minister for Health

I have asked the HSE to provide a direct response to the Deputy on this matter.

Health Services Staff

Questions (955, 956)

Colm Burke

Question:

955. Deputy Colm Burke asked the Minister for Health to provide an update on the independent radiation therapist review which began in December 2022 with representatives from a union (details supplied), his Department, the national cancer control programme, NCCP, and the radiation oncology services; and if he will make a statement on the matter. [40068/23]

Colm Burke

Question:

956. Deputy Colm Burke asked the Minister for Health what action his Department and the HSE are taking to address the critical shortage of radiation therapists in the sector, which has increased from a 15% to a 40% shortage since a survey (details supplied) was carried out earlier this year, and in view that over the summer months, a skin cancer unit had to close for a time due to a lack of qualified staff to operate same; and if he will make a statement on the matter. [40069/23]

Written answers

Minister for Health

I propose to take Questions Nos. 955 and 956 together.

Firstly, I would like to acknowledge the incredibly important role of Radiation Therapists in the provision of cancer services in this country.

An independent review of the Radiation Therapist profession, which was agreed between the HSE, Department of Health and SIPTU, under the auspices of the WRC, has been underway since December 2022. This strategic review has been considering issues such as organisation structure, career development in line with Health and Social Care Professional Frameworks, and strategic workforce planning for Radiation Therapists. It has also been looking at recruitment and retention strategies for Radiation Therapists. All parties expect the recommendations arising from the review to lead to positive changes for the Radiation Therapy profession.

All outcomes of the review will be given due consideration by the Department of Health. Implementation of any recommendations from the review are subject to approval from the Departments of Health and Public Expenditure and Reform in line with public service pay policy. A report of the review containing recommendations is expected to be published in the coming months.

Question No. 956 answered with Question No. 955.

Health Services Staff

Questions (957)

Colm Burke

Question:

957. Deputy Colm Burke asked the Minister for Health the measures that his Department and the HSE are taking to address recruitment and retention in the radiation therapy sector; and if he will make a statement on the matter. [40070/23]

Written answers

Minister for Health

Firstly, I would like to acknowledge the incredibly important role of Radiation Therapists in the provision of cancer services in this country.

An independent review of the Radiation Therapist profession, which was agreed between the HSE, Department of Health and SIPTU, under the auspices of the WRC, has been underway since December 2022. This strategic review has been considering issues such as organisation structure, career development in line with Health and Social Care Professional Frameworks, and strategic workforce planning for Radiation Therapists. It has also been looking at recruitment and retention strategies for Radiation Therapists. All parties expect the recommendations arising from the review to lead to positive changes for the Radiation Therapy profession.

All outcomes of the review will be given due consideration by the Department of Health. Implementation of any recommendations from the review are subject to approval from the Departments of Health and Public Expenditure and Reform in line with public service pay policy. A report of the review containing recommendations is expected to be published in the coming months.

In relation to providing any specific details on recruitment and retention measures for Radiation Therapists, I have asked the Health Service Executive to respond directly to the Deputy.

Vaccination Programme

Questions (958)

David Cullinane

Question:

958. Deputy David Cullinane asked the Minister for Health if he explored extending the flu programme to the 50-64-year-old group first, rather than examining the benefits of an enhanced flu vaccine for the 65+ cohort; and if he will make a statement on the matter. [40096/23]

Written answers

Minister for Health

The National Influenza Vaccination Programme ensures that those most vulnerable to the effects of influenza have access to the flu vaccine, free of charge. By providing vaccination to those most at risk, and those most likely to require admission to hospital should they contract influenza, the programme aims to prevent, as far as possible, the need for influenza-related hospital admissions, as well as to reduce the overall spread of influenza in the community.

As part of the National Influenza Vaccination Programme, the flu vaccine is available to those aged 65 and over and individuals in specified at-risk groups.To inform decision making in relation to the current Influenza Vaccination Programme, my Department requested that HIQA carry out a Health technology assessment (HTA) in relation to vaccination with an enhanced quadrivalent influenza vaccine for those aged 65 and older. In addition, my Department requested that HIQA carry out a HTA on the inclusion of the 50–64 year age group as an at-risk group in the influenza vaccination programme.A HTA is a multidisciplinary research process that collects and summarises information about a health technology to provide information regarding clinical effectiveness and safety, cost-effectiveness and budget impact, organisational and social aspects, and ethical and legal issues. The information is collected and presented in a systematic, unbiased and transparent manner to inform policy decision making.HIQA has now completed the HTA on the inclusion of the 50–64 year age group in the influenza vaccination programme and my Department is considering its findings. I am advised that HIQA has recently commenced the HTA in relation to an enhanced quadrivalent influenza vaccine for those aged 65 and older.

Disease Management

Questions (959)

David Cullinane

Question:

959. Deputy David Cullinane asked the Minister for Health if he has explored the use of the heel prick test for spinal muscular atrophy; and if he will make a statement on the matter. [40097/23]

Written answers

Minister for Health

The expansion of the National Newborn Bloodspot (NBS) Programme is a priority for me, and the National Screening Advisory Committee (NSAC) has been progressing with work on this expansion.

This independent expert group considers and assesses evidence in a robust and transparent manner, and against internationally accepted criteria. It is important that 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. As you will appreciate, these are lengthy and complex processes.

However, I am glad to note that significant progress has been made on expansion over the past 18 months. Since May 2022, babies have been screened for nine conditions following a recommendation from the NSAC to add ADA-SCID to the Programme.

Building on this, in January 2023, I approved a further recommendation from the Committee for the addition of T-cell receptor excision circle (TREC)-based screening for all types of Severe Combined Immunodeficiency (SCID) to the NBS programme which will increase the number of conditions screened as part of the screening programme to ten. The Committee made its recommendation to me based on their consideration of a comprehensive Health Technology Assessment (HTA) report from HIQA. HTAs collect and summarises detailed information about new technologies over a range of fields, including clinical effectiveness and safety, cost-effectiveness and budget impact, organisational and social aspects, and ethical and legal issues.

The HSE is now undertaking an extensive body of work to prepare for implementation. Provision for this addition will be included in the relevant HSE service planning processes in line with HSE budgeting procedures.

In relation to Spinal Muscular Atrophy, a HTA on the addition of SMA as an eleventh condition to the NBS programme, is now underway by HIQA. It will provide evidence-based advice to NSAC and will inform a decision regarding the potential inclusion of SMA in NBS Programme. I am advised that the HTA is at an advanced stage, the NSAC expect HIQA to complete this process shortly and that the HTA will be presented to and considered by the Committee at a meeting before the end of this year.

I look forward to receiving a recommendation from the Committee following their consideration of the HTA once it is available.

Health Strategies

Questions (960)

David Cullinane

Question:

960. Deputy David Cullinane asked the Minister for Health if, in light of HPSC data on excess mortalities seen last winter, he will outline the new measures which he is bringing in for this coming winter to protect the over-65s population of Ireland; and if he will make a statement on the matter. [40098/23]

Written answers

Minister for Health

It is important to note that excess mortality has been observed during previous periods when influenza viruses circulated at high levels in Ireland, for example in winter 2017/2018 which has previously been characterised as a severe flu season, and during certain periods of the COVID-19 pandemic.

As Ireland experienced a winter of high levels of influenza cases and hospitalisations, it would not be unexpected to see excess mortality. Influenza activity was at very high levels in Ireland during December 2022 and early/mid-January 2023, with a high number of influenza hospitalisations reported. Other important factors that may impact excess mortality include the ongoing COVID-19 pandemic, circulation of other respiratory viruses, impacts of cold weather, and an ageing population.

For the winter 2023/2024 free covid and flu vaccines will be available to those aged 65 and over as well as other eligible at-risk groups. The vaccination programmes are scheduled to officially commence in early October. Vaccines can be accessed through GPs or pharmacies. In addition, HSE mobile vaccination teams will administer vaccines to vulnerable, non-mobile and hard-to-reach groups, including those residing in Long Term Care Facilities.

It is anticipated that the alignment of Ireland’s Covid-19 and Influenza Vaccination Programmes during the Autumn and Winter period of 2023/2024 will maximise uptake of both vaccines to eligible cohorts.

The anticipated increase in respiratory viruses circulating during the 2023/2024 winter season highlights the importance of implementing personal non-pharmaceutical interventions such as hand hygiene, cough etiquette, and staying at home when ill with respiratory symptoms. Wearing a face covering/mask is no longer mandatory, however, anyone who wishes to continue to wear a face covering/mask should not be discouraged from doing so.

Nursing and Midwifery Board of Ireland

Questions (961, 962)

David Cullinane

Question:

961. Deputy David Cullinane asked the Minister for Health following the vacancy in May 2023 of the director of midwifery post in the Nursing and Midwifery Board of Ireland, the steps taken to advertise the now vacant post; and if he will make a statement on the matter. [40099/23]

David Cullinane

Question:

962. Deputy David Cullinane asked the Minister for Health if someone has been appointed or recruited to the role of the director of midwifery post in the Nursing and Midwifery Board of Ireland; if so, when this took place; and if he will make a statement on the matter. [40100/23]

Written answers

Minister for Health

I propose to take Questions Nos. 961 and 962 together.

As this question relates to an operational matter of the Nursing and Midwifery Board of Ireland (NMBI), I have referred the question to the NMBI for its attention and direct response to the Deputy.

Question No. 962 answered with Question No. 961.

Health Services Staff

Questions (963)

Catherine Murphy

Question:

963. Deputy Catherine Murphy asked the Minister for Health the number of full-time multiple sclerosis, MS, nurse specialists employed by the HSE in the years of 2021, 2022 and to date in 2023; and the locations in which these MS nurses are located, in tabular form. [40123/23]

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.

Hospital Staff

Questions (964)

Catherine Murphy

Question:

964. Deputy Catherine Murphy asked the Minister for Health the number of WTE optometrists and orthoptists based in CHI Crumlin in the years of 2022 and to date in 2023, in tabular form. [40124/23]

Written answers

Minister for Health

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