Written Answers Nos. 494-514
494. Deputy Jennifer Murnane O'Connor asked the Minister for Health the number of WTE Consultant in Emergency Medicine and Emergency Medicine Registrars based in University Hospital Waterford in the years 2021, 2022 and to date in 2023, in tabular form; and if he will make a statement on the matter. [44675/23]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the deputy directly, as soon as possible.
495. Deputy Jennifer Murnane O'Connor asked the Minister for Health if a new chronic disease management hub will become fully operational in County Kilkenny; the staffing details that would be required for the Hub; and if he will make a statement on the matter. [44676/23]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
496. Deputy Jennifer Murnane O'Connor asked the Minister for Health the number of WTE audiologists by grade employed by the HSE in CHO 5 in the years 2022 and to date in 2023; the locations within CHO5 where these audiologists are based, in tabular form; and if he will make a statement on the matter. [44677/23]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
497. Deputy Jennifer Murnane O'Connor asked the Minister for Health if a person (details supplied) can be provided with a service; and if he will make a statement on the matter. [44680/23]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
498. Deputy Kathleen Funchion asked the Minister for Health the number of WTE speech and language therapist posts in the CAMHS teams in County Wicklow that are currently unfilled; and when will these vacancies be filled, in tabular form. [44687/23]
View answerAs this is a service matter, I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.
499. Deputy Kathleen Funchion asked the Minister for Health the number of children in CHO4 waiting lists for counselling and psychotherapy on initial assessment, initial therapy intervention and further therapy intervention lists, in tabular form. [44691/23]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
500. Deputy Kathleen Funchion asked the Minister for Health the locations within CHO6 where primary care autism assessment teams are located in tabular form. [44695/23]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
501. Deputy Jackie Cahill asked the Minister for Health how long, on average, Coru is currently taking to process appeals for physiotherapists trying to register in Ireland; what steps he is taking to reduce this time period considering the shortage of physiotherapists in Ireland, particularly in light of the extended time periods Coru are taking to consider applications for registration to begin with; and if he will make a statement on the matter. [44702/23]
View answerAs the Deputy will already be aware, CORU (the overall name given to the Health and Social Care Professionals Council and the registration boards of the regulated professions) is Ireland's multi-profession health and social care regulator set up by the Health and Social Care Professionals Act 2005 (Act). The role of CORU is to protect the public by promoting high standards of professional conduct, education, training and competence through statutory registration of health and social care professionals. Each profession designated under the Act has its own registration board which is responsible for both the recognition of international qualifications and the registration of applicants (both Irish qualified and overseas qualified) from its own profession.
Physiotherapy qualifications awarded outside the State are assessed through a process of ‘recognition’ which involves comparison of the qualification with the standard of proficiency required of accredited Irish physiotherapy qualifications. Applicants with overseas qualifications must complete the recognition process before registration can be obtained. CORU have confirmed that the average timeframe for internationally accredited physiotherapists to have their qualification recognised is 75 days based on data from Q1 – Q3 of 2023.
CORU invits applicants whose recognition applications are considered complete and ready to be assessed to apply for registration at that time so that the recognition and registration tasks can be processed in parallel. Once a qualification has been recognised as equivalent to an Irish qualification, an applicant can obtain registration. Members of the public can have confidence in knowing that a physiotherapist's standing and qualifications have been independently verified when registered with CORU. Registration applies to both Irish and overseas trained physiotherapists and CORU have confirmed that the average time for registration is eight weeks.
All applicants for recognition of international qualifications and/or registration have the right to appeal decisions made by registration boards on both recognition and registration applications to the Appeals Committee established by CORU. All appeals made to CORU across the professions are progressed as soon as reasonably practicable. I am advised that the number of appeals in a given year is typically in the order of 1.5% to 7%.
The Appeals Committee panel has three members - a public interest member, a member from another profession and a member of the profession of the appellant. It can do one of the following:
• Confirm the decision of the Registration Board.
• Direct that registration be granted.
• Direct a new recognition decision be made.
• Give other directions to the Registration Board.
Applicants who appeal are also afforded the opportunity to reapply for recognition/registration if they are relying on an appeal following the provision of additional information which they did not submit with their initial application for recognition/registration and if time is of the essence for those applicants.
Appeal timelines have increased from an average of 4-6 months in previous years to in excess of nine months currently. This has resulted from an exponential increase in appeals across all professions in 2022 which has continued into 2023. It should be noted the increase in appeals was commensurate with a significant increase in the volume of applications for recognition in 2022 and 2023. In 2022, there were 28 appeals from internationally qualified physiotherapists and 19 had been received by end-July in 2023 while in 2019 a total of 14 appeal applications were received for all professions.
Appeals have been heard at an accelerated rate since early 2023, with the imperative being due regard to the principles of fair procedures and proportionality in the protection of the public for all aspirant registrants and facilitating access to the register. Timeframes for processing appeals remain under review between the Department of Health and CORU.
502. Deputy Fergus O'Dowd asked the Minister for Health to respond to concerns raised in (details supplied); and if he will make a statement on the matter. [44704/23]
View answer504. Deputy Francis Noel Duffy asked the Minister for Health if he is aware foreign nurses currently working as healthcare assistants in Ireland who meet the UK's nursing and midwifery council's English language qualifications do not currently meet the English qualifications in Ireland; if it will be reviewed; and if he will make a statement on the matter. [44708/23]
View answer542. Deputy Robert Troy asked the Minister for Health if he is aware of the very significant number of overseas fully qualified nurses who can only work as carers, because of a deficiency in their English fluency; and if he has considered how these persons could be supported to resume full nursing roles after a period in Ireland; and if he is aware of the claim that the standard of fluency in English required is higher here than in the UK; and if he will make a statement on the matter. [44894/23]
View answer574. Deputy Brendan Griffin asked the Minister for Health for clarification on a matter (details supplied); and if he will make a statement on the matter. [45078/23]
View answer589. Deputy Bríd Smith asked the Minister for Health if, in light of the shortage of nurses, if the granting of NMBI nursing registration will be considered, after the successful completion of adaptation training or RCSI aptitude test, to those healthcare assistants with a nursing degree/diploma from their home country and who have been working in Ireland for at least two years; if he will acknowledge that most of those working as carers will qualify for Irish nursing registration if the NMBI accepts the English language qualifications prescribed by the UK's Nursing Authority for foreign nurses; and if he will make a statement on the matter. [45164/23]
View answer609. Deputy Peter Burke asked the Minister for Health if he will consider the English qualifications which apply to the Nursing and Midwifery Board of Ireland for nurses from abroad, and the restrictions which this is putting on foreign nurses from registering as nurses in this country; and if he will make a statement on the matter. [45239/23]
View answerI propose to take Questions Nos. 502, 504, 542, 574, 589 and 609 together.
As the Deputies will be aware, all nurses and midwives who practise in Ireland must be registered on the Register of Nurses and Midwives, maintained by the Nursing and Midwifery Board of Ireland (NMBI).
The NMBI are the independent, statutory body which sets the standards for the education of nurses and midwives in Ireland and have a legislated function to protect the public.
In completing this function, rigorous evaluation of information and thorough regulatory checks are required when processing applications from those who want to register to practise in Ireland.
To register to become a nurse or midwife, all applicants need to complete a two-stage process:
1. Recognition of Qualifications
2. Registration.
In the first stage, Recognition of Qualifications, an NMBI Education Assessor will assess evidence of the applicant’s education, qualifications, and credentials against the NMBI standards and requirements to practise in Ireland. Once the application has been assessed as satisfactory, a Decision Letter will issue from the NMBI.
Where the NMBI identifies a deficit between the applicant’s education, qualifications, and credentials against the NMBI’s Standards and Requirements, the Decision Letter will inform the applicant that there is a requirement to complete a ‘compensation measure’. These compensation measures are either a paid period of adaptation placement or an aptitude test; these are mechanisms which allow an applicant to demonstrate their competency to meet the NMBI’s Standards and Requirements for registration. Once the applicant has successfully completed the compensation measure, the recognition process is complete, and they can apply for registration.
As part of the registration process, all registration applicants must demonstrate to the NMBI that they have the necessary proficiency in English to communicate effectively and safely in their practise. The NMBI provides three routes for applicants to demonstrate their English language competency:
Pathway 1: Educated through English in an NMBI-recognised country; or educated through English in an EU country where English is a listed official language
Pathway 2: Registered and Practised in English in an NMBI-recognised country
Pathway 3: Completion of an English language test approved by the NMBI
For many overseas educated applicants, this means taking an English language test and submitting a certificate of test results. The NMBI recognises both the International English Language Test System (IELTS) and Occupational English Test (OET) as verified test providers. IELTS and OET are valid for two years across all Irish regulators and Canadian, Australian, American and UK regulators. This is also the standard validation period across immigration services internationally.
These language tests are carried out by independent third parties, internationally recognised for providing rigorous and evidence-based professional or occupational English testing, specifically for healthcare professionals. Tests can be taken in Ireland, or nearly all other countries.
The Nursing and Midwifery Council (NMC) in the U.K. and NMBI have very similar English qualification standards. The NMC will accept an IETLS score with a minimum of 7.0 for reading, listening, and speaking, and at least 6.5 for writing. The NMC will also accept the OET (Nursing) test result that confirms an applicant achieved at least grade B (350 or above) for reading, listening, and speaking, and at least grade C+ (300 or above) for writing.
The NMC may accept supplementary evidence of clinical competence in English from an applicants’ current employer in the UK if an applicant has taken IELTS or OET at least twice and missed the required scores in any one of the domains by no more than 0.5 (half a grade). The NMC have specific criteria around the use of supplementary evidence of clinical competence in English; it is not standalone evidence, and they are not seeking to expand this at the moment.
The NMBI will accept an overall IELTS score of 7.0 with a minimum of 7.0 in any three components and 6.5 in any one component. The components are writing, reading, listening and speaking. The NMBI will also accept the OET (Nursing) test result with Grade B (350-450) in three components and C+ (300 – 340) in one component. The NMBI do not impose a limit to the number of times an applicant can sit the IELTS or OET and the approach accepted by the NMBI is not prescriptive, in relation to scoring across the components, to allow flexibility for candidates.
Along with the NMBI, as the regulator for the professions of nursing and midwifery, I welcome registration applications from those that were educated overseas. I would like to acknowledge the significant contribution that overseas healthcare service employees provide. I am hugely committed to supporting the nursing and midwifery workforce and ensuring a stable and sustainable nursing and midwifery workforce is a priority for me. My Department is engaging with the NMBI to explore this matter further.
503. Deputy Peadar Tóibín asked the Minister for Health if the catchment rule in terms of access to physio services is a rigid rule that cannot be made flexible to ensure that citizens have access to proper services if a particular catchment area does not have necessary human resources; if this makes access to service uneven; the number of physio, speech and language, social worker and OT personnel that are in place in each catchment area in the country; and the number of each that is considered a full team in each of these catchment areas. [44707/23]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
505. Deputy Robert Troy asked the Minister for Health when a person (details supplied) will be called for an ADHD assessment in Springfield, Mullingar, County Westmeath. [44714/23]
View answerAs this is a service matter, I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.
506. Deputy Pauline Tully asked the Minister for Health if boarding out providers funded through the boarding out regulations under the Health (Nursing Homes) Act 1990 are eligible for the Government’s Inflation Fund for community and voluntary health and social care providers, announced in February 2023; if so, the timeframe within which payment will be made to a person (details supplied); and if he will make a statement on the matter. [44726/23]
View answerAs this is an operational matter, I have asked the Health Service Executive to respond to the deputy directly, as soon as possible.
507. Deputy Aengus Ó Snodaigh asked the Minister for Health is he aware that as of September 2023 the HSE no longer allocates a GP to medical card holders if they are unable to find in their locality a GP with capacity to take them onto their patient lists; and if his attention has been drawn to the fact that in some case severely ill patients whose existing GP is retiring and who are dependent on GPs to issue their repeat three-monthly prescriptions, will now have to rely on attending hospital monthly to ensure continuation of supply. [44728/23]
View answerPatient choice of doctor is a bedrock principle of the GMS Scheme for medical card and GP visit card holders. For the vast majority of individuals concerned their choice of doctor is accommodated and they are registered with their GMS GP of choice. In 2022 (last full year data available) out of a total of about 348,000 individuals who were approved for either a GP Visit Card or Medical Card, 3,927 individuals were unable to secure placement with their doctor of choice, or 1.1% of the total. In addition, 3,701 existing GMS patients were reassigned following a change in their place of residence.
For the small number of individuals unable to locate a GP themselves, the long standing process whereby the HSE may assign an eligible person to a GP’s GMS panel remains in place, in accordance with the GMS contract. Where a patient who holds a medical card or GP visit card experiences difficulty in finding a GP to accept them as a patient, the person concerned having unsuccessfully applied to at least three GPs in the area (or fewer if there are fewer GPs in the area) can apply to the HSE National Medical Card Unit which has the power to assign that person to a GP's GMS patient list.
The GP Agreement 2023, which provides for the expansion of GP care without charges to all children under 8 years and to those who earn up to the median household income, does contain arrangements in relation to the assignment of card holders/applicants to GP GMS panels. However, these arrangements do not prevent the assignment of patients and rather are in place to help the equitable distribution of assigned patients across the panels of participating GPs.
In addition, as per the Agreement, a joint HSE and Irish Medical Organisation working group is being established to review the operation of the patient assignment protocol with a view to ensuring that it is framed and operating in a fair, patient- and GP-centred manner.
508. Deputy Aengus Ó Snodaigh asked the Minister for Health the reason that St. James's Hospital has ended the GP blood clinic (details supplied). [44729/23]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
509. Deputy Aengus Ó Snodaigh asked the Minister for Health is he aware that the Limekiln Lane Health Centre, Dublin, has ended its important development checks on two-year-olds; the steps that are being taken to reopen the service which parents of young children were dependent on; and his views on the matter which is causing stress to parents. [44730/23]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
510. Deputy Emer Higgins asked the Minister for Health regarding the recent shift to charge €30 for blood tests in hospitals, the reason for this change; the measures being considered to address the resultant financial burden on patients; and if he will make a statement on the matter. [44732/23]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
511. Deputy Emer Higgins asked the Minister for Health if hospitals routinely conduct blood tests for alcohol or drug traces in patients admitted after serious car accidents; and if he will make a statement on the matter. [44733/23]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the deputy directly, as soon as possible.
512. Deputy Aengus Ó Snodaigh asked the Minister for Health the steps a person should take to get medical treatment from a doctor, given that their existing GP is retiring and he has been unable to find another practice in Dublin 8, 10, 12, 20 or 22 that will take them on to ensure continuity of treatment for liver disease and continuity of medication after the current three-month prescription runs out; and if he will make a statement on the matter. [44737/23]
View answerGPs are private practitioners, most of whom hold a contract with the HSE for the provision of health services. Under the GMS scheme, the HSE contracts GPs to provide medical services without charge to medical card and GP visit card holders.
For GMS patients unable to locate a GP themselves, the HSE may assign an eligible person to be included on a medical practitioner's GMS list where that person has unsuccessfully applied to at least three GPs in their area (or fewer if there are fewer GPs in the area), in accordance with the GMS contract.
People who do not hold a medical card or GP visit card access GP services on a private basis and can make enquiries directly to any GP practice they wish to register with. As private practitioners, it is a matter for each individual GP to decide whether to accept additional private patients. Neither my Department nor the HSE have any role in assigning patients who do not hold a medical card or a GP visit card to a GP's patient list.
The Government is aware of the workforce issues currently facing general practice, including the limited access to GP services in certain areas, and is working to ensure that general practice is sustainable in all areas into the future.
Under the 2019 GP Agreement additional annual expenditure provided for general practice has been increased now by €211.6m. This provides for significant increases in capitation fees for participating GMS GPs, and new fees and subsidies for additional services. Improvements to GP’s maternity and paternity leave arrangements and a support for GPs in disadvantaged urban areas, have also been provided for. In addition, the enhanced supports package for rural GP practices was increased by 10%.
The recent GP Agreement 2023 announced in July, which provides for the expansions of GP care without charges to those who earn up to the median household income and to children aged 6 & 7, includes additional capacity supports to enable the expansion and retention of staffing within general practice. It includes additional supports for GP Out of Hours services also.
These measures will make general practice in Ireland a more attractive career choice and will see an increase in the number of GPs working in the State, improving access to GP services for patients throughout the country.
The number of doctors entering GP training has been increased in recent years, with 287 new entrants for this year and 350 places for new entrants planned for next year. Annual intake to the GP training scheme has been increased by over 80% since 2015. Furthermore, the joint HSE and ICGP programme underway to bring up to 100 non-EU GPs to Ireland in 2023 will help to quickly improve access to GP services, particularly in areas with limited access. It is planned to bring to Ireland up to 250 more non-EU GPs by the end of 2024.
513. Deputy Carol Nolan asked the Minister for Health if dementia is classified as a disability in his Department's healthcare policy or the policy of the HSE; if not, the reason for same; if there are plans to change this; and if he will make a statement on the matter. [44741/23]
View answerThe 2014 National Dementia Strategy defines dementia as “a syndrome characterised by progressive cognitive impairment associated with impairment in functional abilities and, in many cases, behavioural and psychological symptoms. There may be memory loss, usually related to short-term memory, communication difficulties, changes in personality or mood and problems with spatial awareness.”
The aim of the National Dementia Strategy is to improve dementia care so that people with dementia can live well for as long as possible, can ultimately die with comfort and dignity, and can have services and supports delivered in the best way possible.
The HSE’s Dementia Model of Care, published in May this year, uses the WHO's definition of dementia as a "chronic, multi-factorial and progressive condition. It is not a disease in itself but an umbrella term for a range of conditions, which cause changes to the brain. Dementia has physical, psychological, social, and economic consequences for the person, their carers, supporters, families, and society generally”.
Both the National Dementia Strategy and the Model of Care focus on the health, social care and societal measures that need to be in place to support people with dementia to live as well as possible in their own homes and communities. They do not refer to dementia specifically as a disability and there are no plans to change this.
While recognising that dementia does not solely affect people over the age of 65, dementia policy in the Department of Health, and dementia strategic planning in the HSE through the National Dementia Office, are included under the umbrella of older people's services in both organisations. Notwithstanding this, the Model of Care for dementia includes safeguards and processes to ensure that people under 65 are catered for equitably.
514. Deputy Carol Nolan asked the Minister for Health to address concerns that some older persons who do not hold a medical card are being asked to pay extra money at their chemist in order to get their medication put into a blister pack; if reimbursement options are available for such persons; and if he will make a statement on the matter. [44742/23]
View answerThe Irish Public Health System provides for two categories of eligibility for persons ordinarily resident in the country, i.e., full eligibility (medical cards) and limited eligibility.
In accordance with the provisions of the Health Act 1970 (as amended), eligibility for a medical card is determined by the HSE. Medical card eligibility is primarily based on an assessment of means and is not granted on the basis of any particular condition.
In certain circumstances the HSE may exercise discretion and grant a medical card, even though an applicant exceeds the income guidelines, where he or she faces difficult financial circumstances, such as extra costs arising from illness. 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.
Under the Drug Payment Scheme (DPS), no individual or family pays more than €80 a month towards the cost of approved prescribed medicines. The DPS is not means tested and is available to anyone ordinarily resident in Ireland. The DPS significantly reduces the cost burden for families and individuals with ongoing expenditure on medicines.
“Phased Dispensing” fees were introduced in 1996 as it was recognised that, on occasion, it was important that an individual patient, for their own safety, did not have the total month’s supply in their possession at the one time. Some years later, the Irish Pharmacy Union, which represents most community pharmacists), approached the Department of Health with a proposal to supply medicines in a “Monitored Dosage System” (MDS), advocating their use in improving compliance with medicines. This is a separate issue to “Phased Dispensing”.
There are no reimbursement arrangements under the GMS and DPS schemes for the filling of blister packs (monitored dosage system). It is entirely acceptable for a pharmacy to offer, as a quality initiative, to provide a patient’s medicines in such systems. However, it is a pharmacy arrangement with the patient and is not a state funded service.
Pharmacists cannot claim fees for this as a “Phased Dispensing” service unless (i) the GP has requested for the patient’s safety that the patient’s supply is phased (in which case it must be collected by the patient several times a month) or (ii) the patient cannot manage the full month’s supply of their medicines safely on their own in their home, in which case smaller supplies on a more frequent basis can be dispensed to the patient or their agent.
