Written Answers Nos. 266-286
266. Deputy Richard O'Donoghue asked the Minister for Health when the rapid HTA, undertaken by HIQA in November 2022, reviewing the evidence of the clinical and cost-effectiveness of continuous and intermittent glucose monitoring systems for people with type 1 diabetes, will be published; and if it recommends the widening of access to these devices, if funding will be provided. [41956/23]
View answerThe Health Service Executive (HSE) has statutory responsibility for decisions on pricing and reimbursement under the community schemes, in accordance with the Health (Pricing and Supply of Medical Goods) Act 2013.
In making a relevant reimbursement decision, the HSE is required under the Act to have regard to a number of criteria including clinical efficacy, the health needs of the public, cost effectiveness and potential or actual budget impact. I, as the Minister for Health, have no role in these decisions.
The Health Information and Quality Authority have undertaken a Health Technology Assessment (HTA) in respect of the provision of glucose monitoring devices to adults with Type I diabetes. It is expected that this will be published soon. This HTA will inform the HSE decision-making process.
While preparations in respect of Budget 2024 are ongoing, any health measures introduced will be in the context of the implementation of the health commitments in the Programme for Government and the funding available to progress healthcare priorities.
267. Deputy Aengus Ó Snodaigh asked the Minister for Health to clarify, in a situation such as that of a person (details supplied), where the care of a person is split between their three children, each of whom is working full-time, how they should apply for free incontinence pads. [41961/23]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
268. Deputy Niamh Smyth asked the Minister for Health the number of attendances to the minor injury unit in County Monaghan, per month, from January 2019 to date, in tabular form; and if he will make a statement on the matter. [41963/23]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the deputy directly, as soon as possible.
269. Deputy Pauline Tully asked the Minister for Health how many voluntary and Section 39-funded organisations have been refused the pandemic special recognition payment; and to outline the reasons for refusals. [41964/23]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly.
270. Deputy Pauline Tully asked the Minister for Health if he will address the outstanding requests for the pandemic special recognition payment from voluntary and Section 39-funded organisations; and if he will provide an explanation for delays on these payments for staff members. [41965/23]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly.
271. Deputy Róisín Shortall asked the Minister for Health if the national cancer screening taskforce intends to update the screening guidelines to reduce the age of bowel cancer screening; the timeline the taskforce is working towards; and if he will make a statement on the matter. [41969/23]
View answerAs Minister for Health, I am fully committed to supporting our population screening programmes which are a valuable part of our health service, enabling early treatment and care for many people, and improving the overall health of our population.
The Programme for Government commits to expanding the age range for BowelScreen to those aged 55 to 74, and the HSE plans to commence this in October 2023 with expansion to those aged 59, in addition to the current age range of 60 to 69.
Any decisions about changes in cancer screening, including further extension of the age ranges, will be made on the advice of the National Screening Advisory Committee (NSAC). This independent expert group considers and assesses evidence in a robust and transparent manner, and against internationally accepted criteria. It is important we have rigorous processes in place to ensure our screening programmes are effective, quality assured and operating to safe standards, and that the benefits of screening outweigh the harms.
I would stress to the Deputy that careful consideration must be given to any proposed expansion of Ireland’s screening programmes and that this process must be afforded the necessary amount of time to complete. This includes ensuring that decisions are made based on internationally accepted criteria and scientific rigour.
In this regard, I am pleased to report that the Committee is already progressing work on the further expansion of our cancer screening programmes and has asked HIQA to evaluate the evidence for the further expansion of the age range eligibility for both the BowelScreen and BreastCheck programmes.
Under Europe’s Beating Cancer Plan, an updated European Council Recommendation on cancer screening was published in December 2022. This recommends extended screening for colorectal (bowel) cancer and breast cancer, along with other recommendations in relation to cervical, lung, prostate and gastric cancer screening. The NSAC will consider this Recommendation and advise myself and my Department on the evidence as it applies to Ireland.
Ireland will also be actively engaged with the significant ongoing collaborative work at European level to take forward the updated Recommendation on cancer screening.
272. Deputy Róisín Shortall asked the Minister for Health the steps he is taking to improve the bowel screening programme; his plans to improve GP access to the programme for patient referrals, particularly younger cohorts of patients; and if he will make a statement on the matter. [41970/23]
View answerAs Minister for Health, I am fully committed to supporting our population screening programmes which are a valuable part of our health service, enabling early treatment and care for many people, and improving the overall health of our population.
The Programme for Government commits to expanding the age range for BowelScreen to those aged 55 to 74, and the HSE plans to commence this in October 2023 with expansion to those aged 59, in addition to the current age range of 60 to 69.
Any decisions about changes in cancer screening, including further extension of the age ranges, will be made on the advice of the National Screening Advisory Committee (NSAC). This independent expert group considers and assesses evidence in a robust and transparent manner, and against internationally accepted criteria. It is important we have rigorous processes in place to ensure our screening programmes are effective, quality assured and operating to safe standards, and that the benefits of screening outweigh the harms.
I am pleased to report that the Committee is already progressing work on the further expansion of our cancer screening programmes, and has asked HIQA to evaluate the evidence for the further expansion of the age range eligibility for both the BowelScreen and BreastCheck programmes.
Under Europe’s Beating Cancer Plan, an updated European Council Recommendation on cancer screening (2022/C473/01) was published in December 2022. This recommends extending the population coverage of screening for cervical, colorectal (bowel) and breast cancer in the eligible population. It also sets out other recommendations in relation to lung, prostate and gastric cancer screening. The NSAC will consider this Recommendation and advise myself and my Department on the evidence as it applies to Ireland. The NSAC will consider this Recommendation and advise me and the Department of Health on the evidence as it applies to Ireland.
I would highlight to the Deputy that Ireland will also be actively engaged with the significant ongoing collaborative work at European level to take forward the updated Recommendation on cancer screening.
It is important to emphasise that bowel screening aims to detect signs of bowel cancer at an early stage where there are no symptoms. Any person who has any concerns or has symptoms of bowel cancer should discuss the matter with their GP who can examine the patient and can refer them for further tests as appropriate. Further information regarding symptoms and when to seek medical advice is available on the HSE website.
273. Deputy Richard Bruton asked the Minister for Health the means thresholds and savings thresholds for medical card, and for GP only cards, both for those under 70 years and those aged 70 and over, when the recently announced extension of GP cards is complete; his plans to index either or both to the trend in any income indicator for future years; and if he will make a statement on the matter. [41989/23]
View answerEligibility 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.
The current medical card thresholds are outlined below by cohort:
• Single person living alone under 66 - € 184.00
• Single person living alone 66-69 - € 201.50
• Single person living with family under 66 - € 164.00
• Single person living with family 66-69 - € 173.50
• Couple, married/cohabiting/civil partners, one parent family under 66 - € 266.50
• Couple, married/cohabiting/civil partners, one parent family 66-69 - € 298.00
Income, savings, investments and property (except for applicant’s own home) are taken into account in the means test.
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. In November 2020, the weekly gross medical card income thresholds for those aged 70 and over were increased to €550 per week for a single person and €1050 for a couple.
As provided for under the GP Agreement 2023, the expansion of GP visit card eligibility to all children aged 6 and 7 years commenced from the 11th of August, and the expansion of GP visit card eligibility to all people who earn the median household income or less is underway. The expansion to the median household income will be completed in two phases, the 11th of September 2023, now commenced, and the 13th of November 2023.
Following the recent commencement of the first phase of the median income expansion, the current qualifying weekly financial thresholds for a GP visit card are as follows:
• Single person living alone: €361
• Single person living with family: €322
• Married or co-habiting couple with or without dependents: €524
• Lone parent: €524
After the commencement of the second phase of the median income expansion from the 13th of November, the qualifying weekly financial thresholds for a GP visit card will expand further to:
• Single person living alone aged up to 69: €418
• Single person living with family: €373
• Married or co-habiting couple with or without dependents: €607
• Lone parent: €607
All children under 8 years of age and persons aged 70 years and over are eligible for a GP visit card on the basis of their age. No changes are made under the GP Agreement 2023 in relation to the qualifying weekly financial thresholds for a medical card.
I can assure the Deputy that, in order to ensure the medical card system is responsive and sensitive to people's needs, my Department keeps medical card issues, including the current medical card income thresholds, under review and any proposals are considered in the context of any potential broader implications for Government policy, the annual budgetary estimates process and legislative requirements arising.
274. Deputy Richard Bruton asked the Minister for Health the circumstances in which a charge will be made to a patient visiting the casualty department, visiting an outpatient department or obtaining a blood test, and the level of charge in each case, and the circumstance in which a patient may apply to have such charges waived. [41990/23]
View answerIf you attend the outpatients department or emergency department (A+E) of a public hospital without being referred by your GP or family doctor, you may be charged a standard fee. There is no charge if you are referred by your GP. You must show the referral letter from your GP when you attend the outpatients department or emergency department (A+E).
Since January 1 2009, this charge is €100.
This charge is not applicable if you are in one of the following groups:
Medical card holders
People admitted to hospital after attending the emergency department
People receiving treatment for prescribed infectious diseases - including coronavirus (COVID-19)
Children, in respect of the following diseases and disabilities: “mental handicap, mental illness, phenylketonuria, cystic fibrosis, spina bifida, hydrocephalus, haemophilia and cerebral palsy”
People who are entitled to hospital services because of EU Regulations
Note that in select cases where people have difficulty paying, the HSE may provide the service free of charge. You should also note that return visits in relation to each episode of care will not be subject to any additional charge.
If you are referred by your GP to outpatients for specialist assessment by a Consultant or his or her team for diagnostic assessments such as x-rays, laboratory tests or physiotherapy, there is no charge if you attend as a public patient.
275. Deputy Richard Bruton asked the Minister for Health the concessions offered under the fair deal scheme within the means-testing arrangements where homes of patients have been sold, and where homes of patients have been rented, and if he will indicate the number of instances where this option has been taken up in each case since the concession was put in place. [41991/23]
View answerAs these are operational matters, I have asked the Health Service Executive to respond to the deputy directly, as soon as possible.
276. Deputy Richard Bruton asked the Minister for Health the prescription charges now paid by medical card holders and if the level of these thresholds is under review. [41992/23]
View answerPrescription charges were introduced in the Health (Amendment) (No. 2) Act 2010.
The Government is committed to making healthcare more accessible and affordable and has introduced several reductions in the cost of healthcare.
On 1 November 2020, prescription charges under the General Medical Services (GMS) scheme were reduced as follows:
• To €1.00 per item for persons over 70, with a maximum monthly charge of €10.00.
• To €1.50 per item for persons under 70, with a maximum monthly charge of €15.00.
While preparations in respect of Budget 2024 are ongoing, any health measures introduced will be in the context of the implementation of the health commitments in the Programme for Government and the funding available.
277. Deputy Richard Bruton asked the Minister for Health the threshold for drug refund which is now in place and if the level of this threshold is under review. [41993/23]
View answerThe Drug Payment Scheme (DPS) provides for the refund of the amount by which expenditure on approved prescribed medicines or medical and surgical appliances 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 twice in 2022:
• From €114 to €100 per month on 1 January 2022.
• From €100 to €80 per month on 1 March 2022.
Therefore, currently, under the DPS, no individual pays more than €80 a month towards the cost of approved prescribed medicines. The DPS significantly reduces the cost burden for people with ongoing expenditure on medicines. Consideration of further changes to the DPS threshold will be made in the context of current healthcare priorities and the budget available.
People who cannot, without undue hardship, arrange for the provision of medical services 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.
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. The HSE afford applicants the opportunity to furnish supporting documentation to determine whether undue hardship exists and to fully take account of all relevant circumstances that may benefit them in assessment, including medical evidence of costs and certain expenses. 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.
Individuals may also be entitled to claim tax relief on the cost of their medical expenses. This includes medicines prescribed by a doctor, dentist, or consultant. Relief is at the standard tax rate of 20%.
278. Deputy Richard Bruton asked the Minister for Health if the National Treatment Purchase Fund is on track to deliver the targeted level of procedures, scopes, diagnostic tests and outpatient appointment during 2023, and whether target waiting times for arranging different interventions have been set. [41994/23]
View answerThe 2023 Waiting List Action Plan (WLAP) set ambitious targets for the National Treatment Purchase Fund for this year. As I advised the Deputy in PQ 40277/23 answered on the 21st of September, as of the 25th of August the NTPF had made offers of treatment to 39,160 patients on the IPDC waiting list, 19,388 on the GI Scope list and some 146,244 outpatient appointments had been approved. In addition, 55,874 vouchers for diagnostics (EDANS) had been utilised across hospital groups. Given this level of activity the NTPF is confident that it can meet its targets set in the WLAP.
The NTPF looks to source treatment or an appointment for all patients waiting more than 3 months subject to available public and private capacity. The WLAP identifies 20 specific high volume procedures, that at the end of 2022 accounted for more than 40% of the IPDC waiting list, with a commitment that anyone waiting 3 months or over who is clinically suitable will receive an offer of care from the NTPF. As at the end of August, 80% of patients waiting more than 3 months have either been removed from the waiting list or have received an authorisation for an offer of NTPF funded treatment.
279. Deputy Richard Bruton asked the Minister for Health the estimated number of patients who have been treated abroad under different options in the year to date; if he has any breakdown of this number by procedure or specialty, and if the conditions for obtaining treatment in the UK and Northern Ireland, or in other member states of the EU is likely to change in the coming year; and if he will make a statement on the matter. [41995/23]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
280. Deputy Richard Bruton asked the Minister for Health if he has set prospective dates by which he expects to extend the age groups who qualify for free GP services; and if he will make a statement on the matter. [41996/23]
View answerThe Health (General Practitioner Service and Alteration of Criteria for Eligibility) Act 2020 provides, amongst other things, for the expansion of GP care without charges to all children aged 12 years and under in three phases: for children aged 6 and 7 (Section 4 of the Act); for children aged 8 and 9 (Section 5 of the Act); and for children aged 10, 11, and 12 (Section 6 of the Act). Section 7 of the Act sets out the relevant commencement arrangements.
As announced in July, the Department of Health, the HSE and the IMO reached an agreement, the GP Agreement 2023, to provide for the expansion of eligibility for GP care without charges to all children aged 6 and 7 years and all people who earn the median household income or less. The expansion of free GP care to all children under 8 years of age, estimated to provide GP visit card eligibility to an additional 78,000 6 and 7 year olds, commenced from the 11th of August 2023.
The expansion to the median household income will be completed in two phases, the 11th of September 2023, now commenced, and the 13th of November 2023. Eligibility is determined through means testing, taking into consideration income as well as a range of expenses.
The GP Agreement 2023 provides a package worth €30 million specifically to support capacity in general practice, to retain staff and recruit additional staff to meet demand. There will also be additional support of €2 million to support the GP Out of Hours services. The Government has not set dates to further expand GP visit card eligibility to additional child age cohorts, as provided for under the Act. Reflecting the scale of the current expansion in eligibility for GP care without charges, it is important that GPs have time to make the necessary adjustments and build the necessary capacity to provide services to a significantly greater number of public patients.
281. Deputy Michael McNamara asked the Minister for Health how many recruitment processes for a clinical lead in any area of the health service since 8 February 2020 to date have not included among the job specifications a requirement of clinical experience in that area; if he will list the recruitment processes that did not include the requirement of clinical experience; and if he will make a statement on the matter. [42010/23]
View answerI have asked the HSE to respond directly to the Deputy on this matter
282. Deputy Mary Lou McDonald asked the Minister for Health what funding is available to older persons seeking support to adapt their homes via the health-age-friendly-homes programme; what steps older persons seeking support should take to access this funding; and if he will make a statement on the matter. [42011/23]
View answerHealthy Age Friendly Homes is the support coordination service which seeks to improve the health and wellbeing of older adults and to enable them to remain in their own homes and communities for as long as possible. An innovative collaboration between Health, Housing, and Local Government, through the Age Friendly Ireland Shared Service, this programme has been operational in nine pilot sites since July 2021. This programme establishes the unique role of the Local Coordinator, who is situated in local government and who operates at the interface between health and housing. They act as a single point of contact for older adults as a catalyst to signpost services on their behalf.Referral into the programme can be made by the older person themselves, or by a family member, friend, GP, carer, or member of their community. On referral into the programme, their Local Coordinator will carry out a home visit to conduct a holistic assessment of needs in the areas of health, housing adaptations, home energy assessments and retrofits, community and social supports, and assistive technologies.Where a need for a housing adaptation is identified, the coordinator will assist with the application process in order to avail of the relevant grants (e.g. housing adaptation grant, mobility aid grant). Similarly, the programme has established a partnership with SEAI to provide home energy assessments, BER assessments, and energy retrofits for older adults.Following a successful pilot funded by Sláintecare, the programme has received funding of €5.2m in Budget 2023 to roll out nationally. This funding provides for 44 Local Coordinators, 6 Regional Managers, and 16 administrative support staff to deliver supports and advice to older people nationwide. This means that there will be a Local Coordinator for each of the 31 Local Authorities and two coordinators in certain areas based on identified need. These roles are funded by the HSE, and employed by Meath County Council as host of the Age Friendly Ireland Shared Service. Local Coordinators will also be provided with a small programme budget in each local authority to facilitate local engagement and promotional activities. The programme will be coordinated across six regions, aligned to the six new HSE Health Regions.Work to progress the recruitment of the 44 Local Coordinators and 6 Regional Managers through the Public Appointments Service has progressed over the summer period, with 5 out of 6 regional managers in place and coordinators expected to take up post in the coming weeks. The national programme launch will take place in the Autumn.
283. Deputy Eoin Ó Broin asked the Minister for Health if he is aware that referrals for occupational therapy in the Dublin south, Kildare and west Wicklow primary care region are taking 26 months from the original date of referral, for both assessment and issuing of equipment; his views on whether this is acceptable; what efforts the HSE is making to ensure a timely service in occupational therapy in the area; and if he will make a statement on the matter. [42012/23]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
284. Deputy Michael Healy-Rae asked the Minister for Health the status of an urgent appointment (details supplied); and if he will make a statement on the matter. [42014/23]
View answerUnder 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.
285. Deputy Carol Nolan asked the Minister for Health if he will investigate serious concerns regarding a lack of information raised by the parents of a child (details supplied) who has undergone treatment at Temple Street Hospital for hip dysplasia; and if he will make a statement on the matter. [42025/23]
View answerThis has been referred to the HSE.
286. Deputy Noel Grealish asked the Minister for Health the current progress regarding the HSE recognising the NASRA as a union with collective bargaining rights; and if he will make a statement on the matter. [42030/23]
View answerFirstly, I would like to acknowledge the hard work and dedication of all ambulance staff across the country, including those who are represented by NASRA.
It is important to note that the Department of Health has had a long-standing objective of avoiding fragmentation in worker representation in public sector employments and in the trade union movement generally. Less fragmentation facilitates the orderly conduct of bargaining and other aspects of industrial relations. As such, for public service ambulance grades in the health sector, it is SIPTU and UNITE that have negotiating rights with the HSE and the National Ambulance Service. While individuals have a right to membership of any trade union, including NASRA, this membership is not required to be facilitated or recognised by their employer.
The HSE and the National Ambulance Service will continue to engage with SIPTU and UNITE in relation to the public service ambulance grades they represent.
