Written Answers Nos. 221-243
221. Deputy Rose Conway-Walsh asked the Minister for Health further to Parliamentary Question No. 1223 of 13 June 2023, if he could provide a breakdown of the €332.2 million spent on 'business as usual' outsource by the HSE in 2022; and if he will make a statement on the matter. [44319/23]
View answerIn relation to the information requested by the Deputy, as this is an operational matter, I have forwarded your query to the HSE and asked that they respond directly to you as soon as possible.
222. Deputy Mark Ward asked the Minister for Health if he will provide details of the judgements made against Ireland in the Court of Justice of the European Union in each of the past five years in respect of matters which are the responsibility of his Department; the nature of the cases and judgements in question; the total amount in euro of fines and/or penalties paid to date associated with each adverse finding broken down by amount paid by day, week, month and so on, as per the judgement; the remedial procedures, if any, that have been undertaken by the State to address each of the judgements; and if he will make a statement on the matter. [44333/23]
View answerIn respect of matters which are the responsibilities of my Department, the Court of Justice of the European Union has not made any judgements against Ireland in each of the past five years and as such no fines or penalties have been paid.
223. Deputy Michael McNamara asked the Minister for Health if he will expedite a medical card application form for a sight test for a person (details supplied); and if he will make a statement on the matter. [44342/23]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
224. Deputy Peadar Tóibín asked the Minister for Health if he will regulate the Narconon’s residential drug rehabilitation centres to ensure that clients are safe. [44360/23]
View answerThe Department has no jurisdiction over agencies that provide private addiction treatment services. The Health Information and Quality Authority (HIQA) is the independent authority established to drive develop standards, inspect and review health and social care services, however HIQA’s remit does not extend to the regulation or inspection of residential treatment or rehabilitation centres specialising in addiction.
Under the Health Act 2004, as amended, the HSE is responsible for the provision of health and personal social services including addiction services. The HSE either providers these services directly or contracts to have them provided on its behalf. Organisations which provide addiction services and are funded by the HSE are required to meet minimum standards in the delivery of services across a range of criteria which form the basis of any Service Level Agreement (SLA).
Organisations which provide addiction services and are funded by the HSE are required to meet minimum standards in the delivery of services across a range of criteria which form the basis of any service level agreement. As part of the SLA, there is a requirement for the agency to agree to implementing the National Standards for Safer, Better Healthcare published by HIQA in 2012 National Standards for Safer Better Healthcare | HIQA In addition, many of the agencies also receive accreditation through other bodies, for example CCQI from the Royal College of Psychiatrists UK.
The HSE has previously advised the Department that Scientology’s drug treatment programme has no standing amongst medical professionals involved in the treatment of persons with alcohol and drug use disorders. It comprises a series of interventions (Narconon) with limited or no basis in scientific understanding of human physiology and brain functioning and may potentially be harmful directly (with overuse of vitamins and other products) and indirectly (in that persons are engaging in an intervention with no evidence of potential benefits for them). This approach is not endorsed by the national Institute On Drug Abuse (NIDA) in the USA.
225. Deputy Mark Ward asked the Minister for Health the interactions between CAMHS and the Integrated Children’s Service Forum; and if he will make a statement on the matter. [44362/23]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly as soon as possible.
226. Deputy Róisín Shortall asked the Minister for Health to provide an update on plans to move all HSE facilities to a single pay-roll system given that this was to be implemented by July 2023 according to a representative organisation (details supplied); the arrangements for Section 38 facilities; the timeline for implementation of a single payroll system; and if he will make a statement on the matter. [44363/23]
View answerAs this question relates to an operational matter, I have referred it to the HSE for direct response.
227. Deputy Emer Higgins asked the Minister for Health if he will engage with the Revenue Commissioners to ensure GMS income declaration can continue to be paid through partnerships, as changing this practice could lead to financial uncertainties, disrupt GP services and contradict Sláinte Care's preferred partnership model; and if he will make a statement on the matter. [44373/23]
View answerThe collection of taxes and issues relating to the interpretation of tax law are a matter for the Revenue Commissioners. However, I am aware of the concerns raised regarding new guidance to be issued shortly by the Revenue Commissioners regarding the tax treatment of GP's GMS income.
Officials from my Department and and the HSE have engaged with the Office of the Revenue Commissioners and the Department of Finance to understand the context of the new guidance and to identify the potential operational issues which may arise following its publication.
Importantly, the guidance does not reflect a change in tax law, but clarifies how GPs’ GMS income should be treated for the purposes of tax under current tax law. To assist GPs and GP practices in complying with their obligations under tax legislation, Revenue will publish detailed guidance shortly. This will supplement the guidance issued to tax practitioners, through the Tax Administration Liaison Committee, in July of this year clarifying the correct tax treatment of GMS income. To allow GPs and GP practices time to make any necessary adjustments to their arrangements to ensure compliance with applicable tax policy and legislation, Revenue have implemented transitional arrangements up to the end of 2023. From 1 January 2024, those GPs and GP practices should account for tax on GMS income in accordance with the legislation in this area.
My Department and the HSE are also engaged with the IMO and will remain engaged with them to address the potential operational issues raised.
The Strategic Review of General Practice, which is now underway, will examine the current contractual arrangements for the GMS, as well as other issues, and will propose measures necessary to modernise the contract.
228. Deputy Eoin Ó Broin asked the Minister for Health if there is a further update is available regarding the new primary care centre at Boot Road, Clondalkin, Dublin 22 given we have reached Q4 2023, despite previous commitments of opening in Q3; if a date is available for when services will commence; and if he will make a statement on the matter. [44377/23]
View answerAs the Health Service Executive (HSE) holds responsibility for the provision, along with the maintenance and operation of Primary Care Centres, I have asked the HSE to respond directly to the Deputy as soon as possible.
229. Deputy Alan Kelly asked the Minister for Health if the HSE fully respects and understands a Supreme Court judgement in the case of a person (details supplied) which was ruled on in March 2020. [44394/23]
View answerI can confirm that the HSE fully respects and understands a Supreme Court judgement in this case which was ruled on in March 2020.
230. Deputy Róisín Shortall asked the Minister for Health if he is considering the fortification of bread and flour with folic acid, given its role in the prevention of neural tube defects such as spina bifida; the reason mandatory fortification has not been implemented, in view of the evidence to support this measure and the 2006 recommendation of the National Committee on Folic Acid Food Fortification in relation to white, brown and wholemeal breads (details supplied); and if he will make a statement on the matter. [44428/23]
View answerThe Healthy Ireland Framework has brought a new focus on the importance of health promotion and the need for cross-Government and cross-sectoral co-operation to prevent ill-health. The Healthy Ireland Framework has enshrined the principles of prevention and early intervention within all policies, with a particular emphasis on the early years.
Following the publication of healthy eating guidelines for the general population in 2016, it was recognised that dietary intake of folate remains sub optimal In Ireland. A multidisciplinary Committee was established by the Department of Health to review the evidence in support of folic acid supplementation to prevent neural tube defects (NTD). Recommendations published in the 2019 report “Folic Acid Supplementation” by the Department of Health, outline several mechanisms to improve folic acid intake for women of child-bearing age and thereby reduce the risk of neural tube defects.
One key recommendation given at the time was to consider the requirements for food fortification with folate. The Committee recognised that this option is dependent on a range of issues including food consumption patterns and preferences, supply chain issues, implications of Brexit, as well as the significant undertaking in terms of resources and timing involved. These issues would need to be worked through before any further consideration could be given to mandatory food fortification.
Ireland does not have any national mills and relies on the UK for up to eighty per cent of its flour supply. After undertaking a public consultation on the proposal to introduce mandatory fortification of UK flour with folic acid, the UK Government and devolved administrations decided to proceed with the mandatory fortification of non-wholemeal wheat flour and legislate on this basis in 2021.
Up to this point fortification of flour was conducted on a voluntary basis. The voluntary addition of vitamins and minerals to foods is regulated by means of Regulation (EC) No 1925/2006, which aims to ensure that fortified foods are safe, and to allow for the proper functioning of the internal market. This regulation permits the addition of folic acid to foods in compliance with its rules.
The ‘mandatory addition’ of vitamins and minerals for public health reasons, such as the fortification of staple foods with folic acid, is not covered by this regulation. The European Commission does not envisage the harmonisation of the mandatory addition of nutrients, such as folic acid, across the EU. It is up to Member States to decide if they wish to introduce alternative measures such as mandatory food fortification with folic acid.
In addition, the labelling of a compound food containing a fortified ingredient must comply with the provisions of Regulation (EU) No 1169/2011, to ensure that it shall not be misleading for the consumer.
In the event of any proposal to revise existing legislation a regulatory impact analysis would need to be conducted. Before any policy position is finalised on folic acid fortification, stakeholder consultation would need to be carried out on a national basis. Once a policy position has been formed, the Department would need to notify the Commission via the Technical Regulation Information System (TRIS) system of Ireland’s intention to introduce fortification of flour with folic acid. Ireland would be required to demonstrate that evidence-based analysis, public stakeholder consultation and cross Government collaboration had taken place to justify why Ireland is considering mandatory fortification. To give an estimation of predicted timelines, the consultation process is still ongoing in the UK, two years post announcement of mandatory fortification.
With this in mind, other actions are needed to optimise both Folic Acid supplement use and dietary folate in the short-term. It is recommended that all women considering pregnancy take a 400-microgram (mcg) supplement of folic acid per day when planning a pregnancy and for the first 12 weeks of pregnancy and this is described in The Nutrition in Pregnancy, national clinical guideline that was developed in 2019 to promote the link between good nutrition during pregnancy and a favourable pregnancy outcome.
Under the phase 2 of the First 5 strategy implementation plan, it has been identified that parents, families and communities will be supported to engage in and promote positive health behaviours among babies and young children, starting from the pre-conception period. Enhanced integration and communication of Folic Acid supplement advice will continue under several relevant programmes being operated by the Health and Wellbeing Division, Primary Care, Obstetrics and Gynaecology and Sexual Health services.
231. Deputy Patrick Costello asked the Minister for Health in relation to a WRC ruling (details supplied) when the back dated payments will be made to all Sector 38 organisations. [44430/23]
View answerAs this is a service matter, I have asked the Health Service Executive to respond directly to the Deputy.
232. Deputy Róisín Shortall asked the Minister for Health if there is an ongoing collection of data regarding the relationship between pregnancy outcome indicators and alcohol consumption patterns during pregnancy; if he plans to establish a national register for foetal alcohol spectrum disorder; and if he will make a statement on the matter. [44431/23]
View answer233. Deputy Róisín Shortall asked the Minister for Health if there are plans to develop clear clinical guidelines for the diagnosis of foetal alcohol spectrum disorder; and if he will make a statement on the matter. [44432/23]
View answer234. Deputy Róisín Shortall asked the Minister for Health if his attention has been drawn to the concerning prevalence of foetal alcohol spectrum disorder in Ireland, along with the absence of dedicated health messaging addressing this issue; if there are plans in place to initiate a new public health awareness campaign outlining the dangers of alcohol consumption, and discouraging its use during pregnancy; and if he will make a statement on the matter. [44433/23]
View answer236. Deputy Róisín Shortall asked the Minister for Health the current strategies in place to ensure clinical staff receive sufficient training in foetal alcohol spectrum disorder (FASD) to seek information on the efforts being made to enhance awareness of FASD among healthcare professionals and educators; and if he will make a statement on the matter. [44435/23]
View answer237. Deputy Róisín Shortall asked the Minister for Health the measures being taken to ensure that individuals with foetal alcohol spectrum disorder (FASD) and their families have access to FASD-informed services in healthcare, education and social services tailored to their specific needs; and if he will make a statement on the matter. [44436/23]
View answerI propose to take Questions Nos. 232, 233, 234, 236 and 237 together.
Foetal alcohol spectrum disorder (FASD) is a public health issue arising from the consumption of alcohol during pregnancy. FASD is a group of disorders caused by prenatal alcohol exposure and are associated with a range of lifelong physical, mental, educational, social, and behavioural difficulties.
Effective actions to prevent FASD include public health measures targeting the price, availability and accessibility of alcohol, pregnancy warning labels on alcohol products, communications campaigns, routine screening and brief interventions by healthcare professionals, healthcare supports for pregnant women, training and professional development supports for staff, and research and public health surveillance. Timely diagnosis and treatment for children with FASD is required.
The HSE position and action plan on foetal alcohol spectrum disorder (FASD) is outlined here - HSE Position on Prevention of Fetal Alcohol Spectrum Disorders. It has appointed a Clinical Lead for FASD Prevention. It has published health messages on the topic here
HSE urges alcohol-free pregnancy on Fetal Alcohol Spectrum Disorders (FASD) Awareness Day - HSE.ie
Alcohol during pregnancy - HSE.ie
I have asked the HSE to respond to the deputy directly on progress in implementing its action plan and the specific queries that the deputy has set out.
Question No. 233 answered with Question No. 232.
Question No. 234 answered with Question No. 232.
235. Deputy Róisín Shortall asked the Minister for Health to provide a comprehensive summary of any task forces or committees established within the past decade that have focused on alcohol consumption during pregnancy, including their respective recommendations and the status of implementing these recommendations; and if he will make a statement on the matter. [44434/23]
View answerThe Health Service Executive (HSE) has undertaken a number of communication campaigns on the importance of avoiding alcohol during pregnancy. As this falls within its responsibility I have referred this question to the HSE for attention and direct reply.
Question No. 236 answered with Question No. 232.
Question No. 237 answered with Question No. 232
238. Deputy Patricia Ryan asked the Minister for Health the urgent measures he will take to address the serious matter of home care hours and full homecare packages being granted, but not being fulfilled, due to no staff being available to resulting in a person (details supplied); when the care package will be fulfilled; and if he will make a statement on the matter. [44470/23]
View answerAddressing the shortage of care workers in Ireland is an urgent priority for the Government. To this end, the cross-departmental Strategic Workforce Advisory Group was established in March 2022 to examine, and formulate recommendations to address, the challenges in frontline carer roles in the home support and long term residential care sectors.
The Group was chaired by the Department of Health and comprised representatives from seven government departments (Children, Equality, Disability, Integration and Youth; Enterprise, Trade and Employment; Health; Higher and Further Education, Research, Innovation and Science; Justice; Public Expenditure and Reform; and Social Protection), the HSE, HIQA and SOLAS.
The Report was published on 15 October 2022. Providing an overview of the work of the Group and its key findings, the report presents a suite of 16 recommendations spanning the areas of recruitment, pay and conditions of employment, barriers to employment, training and professional development and sectoral reform.
Implementation of the 16 recommendations is being overseen by a cross departmental Implementation Group, chaired by the Department of Health. The Department is engaging with recommendation owners to define an implementation plan. A meeting of the group took place on 29 June. The implementation group will meet quarterly and publish progress reports thereafter.
Recommendation 9 has been implemented. The Statutory instrument authorising the issuance of 1,000 employment permits for homecare workers was signed on 16 December 2022. Work is underway on all recommendations, with a further four at an advanced stage.
As this is an operational matter, I have asked the Health Service Executive to respond to the deputy directly, as soon as possible.
239. Deputy Patricia Ryan asked the Minister for Health if he has plans in place for the residents of a nursing home (details supplied) which is due to close imminently; if he liaised with the HSE to find a suitable property; the plan that is in place; and if he will make a statement on the matter. [44471/23]
View answerOn 26 September 2023, HIQA’s Chief Inspector of Social Services issued a notice of decision to cancel the registration of Belgooly Nursing Home. Aperee Living Belgooly Ltd has until 25 October to notify the Chief Inspector whether it intends to appeal this decision in the District Court.
If the decision to cancel takes effect the HSE will operate the centre until all residents have been supported to find alternative accommodation.
Cancellation of the registration of a nursing home is not the same as closure. When the Chief Inspector cancels the registration of a nursing home, under section 51 of the Health Act (2007) the HSE is required to take charge of the nursing home until such time as alternative homes are found for all residents and they are safely discharged. The Chief Inspector has been in close contact with the HSE since the notice of decision to cancel was issued.
The decision to cancel the registration of a designated centre is taken very seriously and after much deliberation. HIQA engaged in a series of inspection visits to Aperee nursing homes. Six of these are detailed in the publication of Thursday, 7 September on the HIQA website. Across all these Aperee facilities, the Chief Inspector is concerned about the registered provider’s ability to sustain a safe, quality service.
There has been ongoing regulatory engagement between HIQA and Aperee, including provider meetings, and cautionary and warning meetings in relation to governance, management and fire safety.
Further inspections have been completed over the summer period and further engagement with the group has taken place. Many of these are unannounced inspections, which I note are an important part of the inspection process. I fully support HIQA in this approach.
HIQA inspections have uncovered financial irregularities in relation to residents’ incomes within six nursing homes in the Aperee Group.
The Chief Inspector will use all powers available to her office to perform the necessary functions to investigate this under the Regulations and Health Act 2007. The Chief Inspector is fully supported by both the Minister of Health and myself, who will provide the necessary resources and supports.
A HIQA inspection report for Aperee Living, Belgooly nursing home highlighted very significant and concerning issues. Inspectors were concerned about the governance and management of the centre especially in areas of residents’ finances, and in areas of continued non-compliance, particularly fire safety management and premises issues, which had not been addressed by the provider.
A restrictive condition had already been attached to the registration of the centre in March, to stop further admissions until the fire safety works were completed. This condition was put in place to protect current, and any future residents. At the time of the inspection no substantial fire safety works had commenced.
The report also found, upon review, additional non-compliances from the previous inspection that had not been acted upon in the intervening period. Further action was necessary regarding regulations on infection control, staffing, care planning, health care, nutrition, and residents' rights.
In the event the Chief Inspector has ongoing concerns about the safety of residents, she can apply to the District Court for a more immediate order to close the nursing home. If this order was granted, the HSE would be required to take over the operation of the nursing home with immediate effect, sooner than the above date.
When nursing homes close ensuring the welfare and safety of residents is essential.
It should be noted that the HSE has a statutory responsibility as provider of last resort and will continue to support families in situations where a private nursing home is no longer able or willing to provide care under Fair Deal to a loved one. The HSE have been informed and are working closely with Aperee Belgooly, the residents and their families to ensure an orderly transition of the residents to alternative nursing homes.
In May 2023, the centre had 54 residents in situ; with assistance from the HSE, there are under 20 residents still in care at this facility.
As Minister with special responsibility for Mental Health and Older People, I am deeply concerned at the level of non-compliance in evidence from the Aperee inspection reports. The welfare of the residents is at the forefront of my concerns, and I fully support HIQA in upholding these vitally important regulatory standards.
Residents and their families must be consulted and given appropriate notice so that new homes can be found when nursing homes intend to close, when they cease participating in the Nursing Homes Support Scheme (NHSS) or where registration has been cancelled and closure orders have been secured by HIQA. This ensures that residents can move in a safe, planned way.
Pending these alternative arrangements, the HSE, either with the consent of the registered provider or by order of the District Court, shall take the charge of the designated centre to ensure safe and appropriate care of the residents.
240. Deputy Patricia Ryan asked the Minister for Health the number of dementia advisors for each CHO area since Covid in each of the years 2020, 2021, 2022 and to date in 2023, in tabular form. [44474/23]
View answerAs this is an operational matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
241. Deputy Mark Ward asked the Minister for Further and Higher Education, Research, Innovation and Science if he will provide details of the judgements made against Ireland in the Court of Justice of the European Union in each of the past five years in respect of matters which are the responsibility of his Department; the nature of the cases and judgements in question; the total amount in euro of fines and/or penalties paid to date associated with each adverse finding broken down by amount paid by day, week, month and so on, as per the judgement; the remedial procedures, if any, that have been undertaken by the State to address each of the judgements; and if he will make a statement on the matter. [44332/23]
View answerMy Department is continuing to review relevant records to establish the situation in relation to information of the kind sought by the Deputy, i.e. with regard to judgements made against Ireland in the Court of Justice of the European Union in each of the past five years in respect of matters which are the responsibility of my Department. As soon as this process has concluded, I will ensure that an appropriate response is forwarded to the Deputy, including with respect to any such relevant judgements.
242. Deputy Brendan Griffin asked the Minister for Further and Higher Education, Research, Innovation and Science for clarification on a matter (details supplied); and if he will make a statement on the matter. [44393/23]
View answerOn 25 August 2023, SUSI issued a letter to the student referred to by the Deputy advising them they needed to re-apply as a dependent student with their parents’ details. To date the student has not reapplied as a dependent student. I would encourage the student to make an application.
243. Deputy Mark Ward asked the Minister for Rural and Community Development if she will provide details of the judgements made against Ireland in the Court of Justice of the European Union in each of the past five years in respect of matters which are the responsibility of her Department; the nature of the cases and judgements in question; the total amount in euro of fines and/or penalties paid to date associated with each adverse finding broken down by amount paid by day, week, month and so on, as per the judgement; the remedial procedures, if any, that have been undertaken by the State to address each of the judgements; and if she will make a statement on the matter. [44337/23]
View answerMy Department was established in July 2017. Between that date and 2023 to date, I can confirm that there have been no judgements made against Ireland in the Court of Justice of the European Union in respect of matters which are the responsibility of my Department.
