Written Answers Nos. 596-612
596. Deputy Peadar Tóibín asked the Minister for Health how many patients in receipt of high-tech medications are eligible for bio-similar medicines but have not opted to be switched to them; the estimated savings that could be achieved if all patients who were eligible were switched to bio-similar medicines; and if he will make a statement on the matter. [46564/23]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
597. Deputy Michael Lowry asked the Minister for Health following a recommendation made by the WHO in 2021, to provide an update on his Department’s progress in developing a National Hearing Care Plan; and if he will make a statement on the matter. [46565/23]
View answerThe World Health Organisation’s World Report on Hearing published in March 2021 recommends, among other things, that governments develop a comprehensive people-centred hearing care plan within their national health care plan.
The Health Service Executive (HSE) published revised Best Practice Guidelines for the Provision of Hearing Aid Services for Adults in Ireland on the 7 February 2023. The HSE also published Quality Standards for Paediatric Community Audiology Services on the 13 October 2022. These standards are sequenced to reflect the patient pathway. In addition, the roll-out of a National Audiology Clinical Management system in 2020 is facilitating accurate data collection in respect of community audiology services.
In light of these recent developments, the Department had engaged with the HSE regarding the need for an additional hearing care plan. The Department will lead on the development of such a plan, with considerable input from the HSE. Other relevant stakeholders will also be invited to provide input as needed. This work will take place in tandem with other efforts to improve health outcomes for all those suffering from hearing loss.
598. Deputy Richard Bruton asked the Minister for Health how the recruitment embargo will be managed to protect front line delivery, while other cost control measures are evolved; whether measures such as exempting the appointment of dentists, while continuing the embargo on dental nurses are self-defeating as one requires the other to deliver service. [46572/23]
View answerAs the Deputy is aware, on October 13th, the HSE CEO announced a recruitment pause on all Grades that have grown beyond their recruitment targets for 2023. This is an extension of the pause on the recruitment of new and replacement staff in all grades in the Management and Administration category, announced a number of weeks ago.
The recruitment pause will include:
- Management and Administration posts
- Patient and client care (attendants/healthcare assistants/home help)
- Non-Consultant Hospital Doctors
- General Support
The recruitment pause is part of a suite of control measures, including an instruction to reduce expenditure on agency staff and management consultants across the HSE and Section 38 organisations.
Many areas of the HSE have been recruiting more staff than they are funded for. If this level of growth, in excess of budgeted targets, was allowed to continue uncontrolled, it would have significant financial implications for 2023 and following years, and adversely impact on the HSE’s ability to recruit essential patient facing staff next year.
This recruitment pause will exclude the following categories of staff, which have not exceeded their recruitment targets for 2023:
- Approved Consultant Posts & GP Training Posts
- Nursing and Midwifery
- Dentists & Orthodontists
- Health & Social Care Professionals
- National Ambulance Service Pre-Hospital Care
Apart from these above posts, and a certain number of posts in other categories which are at offer/contract stage, there will be no further growth in health sector workforce in 2023.
As there are element of the Parliamentary Question that relates to an operational issues, it is a matter for the HSE. However, members of the Oireachtas are advised that the HSE is currently not in a position to answer PQs due to industrial action. It is hoped that normal services will resume soon. In the meantime, this Department will continue to refer PQs to HSE for their direct reply as soon as possible.
599. Deputy Catherine Murphy asked the Minister for Health in the context of the Local Government Reform Act 2014, if he will provide a schedule of functions of his Department that have been devolved in full or in part, or are in the process of being devolved in full or in part; the date on which the devolutions commenced; and if he will indicate whether any function was returned to the Department subsequently. [46584/23]
View answer600. Deputy Anne Rabbitte asked the Minister for Health if the fitting of a permanent AV fistula is covered under GMS; and if he will make a statement on the matter. [46596/23]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
601. Deputy Anne Rabbitte asked the Minister for Health the number of patients in each CHO area for the years 2019 to 2022 and to date in 2023 that are waiting to have a permanent AV fistula fitted; how long each patient has been waiting in each CHO area, in tabular form; and if he will make a statement on the matter. [46598/23]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
602. Deputy Bernard J. Durkan asked the Minister for Health the measures that his Department and the HSE are taking due to the increase in the outbreaks in head lice, scabies and bed bugs across the country; if there is a reason for the increase in such outbreaks; if any specific measures will be put in place to avoid any further outbreaks due to people returning to this jurisdiction from abroad; and if he will make a statement on the matter. [46620/23]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
603. Deputy Mick Barry asked the Minister for Health if he will outline, in view of testimony to the Oireachtas Health Committee on 18 October 2023 (details supplied) that according to research women were actively obstructed by GPs in accessing abortion health care, the measures he will take to ensure that this practice is stopped as a matter of urgency; and if he will make a statement on the matter. [46626/23]
View answerThe final Report of the Review of the operation of the Health(Regulation of Termination of Pregnancy) Act was considered by Cabinet at the end of April 2023. The Report made a range of recommendations, most of which are operational in nature with some proposing legislative change. The HSE has established, as agreed by the Government, an implementation group to progress the operational recommendations.
Significant progress is being made in respect of recommendations in the Report. The HSE has advised that a significant number of additional sites will be introducing termination services in the coming months. Legislation providing for safe access zones has been initiated in the Houses and Committee Stage is scheduled for 25th October and the intention is that the Bill will be enacted by the end of this year.
The proposals recommending legislative changes have been referred to the Joint Committee on Health for consideration.
604. Deputy Michael Ring asked the Minister for Health when the announcement was originally made for a facility (details supplied); who made the announcement; what funding has been put in place; whether a contractor has been appointed; the up-to-date position of same; and if he will make a statement on the matter. [46631/23]
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.
605. Deputy Louise O'Reilly asked the Minister for Health how many staff are currently employed in a range of posts (details supplied); and how many vacancies currently exist for the same posts; in tabular form. [46635/23]
View answerAs this Parliamentary Question relates to an operational issue, it is a matter for the HSE. However, members of the Oireachtas are advised that the HSE is currently not in a position to answer PQs due to industrial action. It is hoped that normal services will resume soon. In the meantime, this Department will continue to refer PQs to HSE for their direct reply as soon as possible.
606. Deputy Brendan Griffin asked the Minister for Health if a person who is registered as blind meets the qualifying criteria for a primary medical certificate; and if he will make a statement on the matter. [46639/23]
View answerResponsibility for the Disabled Drivers and Disabled Passengers (Tax Concessions) Scheme, operated by the Revenue Commissioners, falls under the remit of the Minister for Finance. To qualify for the scheme, an applicant must hold a Primary Medical Certificate.
In order to obtain a Primary Medical Certificate an applicant must be permanently and severely disabled, within the terms of the Disabled Drivers and Disabled Passengers (Tax Concessions) Regulations 1994, and satisfy at least one of the following medical criteria:
- be wholly or almost wholly without the use of both legs;
- be wholly without the use of one leg and almost wholly without the use of the other leg such that the applicant is severely restricted as to movement of the lower limbs;
- be without both hands or without both arms;
- be without one or both legs;
- be wholly or almost wholly without the use of both hands or arms and wholly or almost wholly without the use of one leg;
- have the medical condition of dwarfism and have serious difficulties of movement of the lower limbs.
The extent of the involvement of health personnel in the scheme relates to making a professional clinical determination as to whether an individual applicant satisfies the medical criteria set out in the Department of Finance regulations. This determination is undertaken by Senior Medical Officers for the relevant local Health Service Executive (HSE) Community Health Organisation, on behalf of the Revenue Commissioners. HSE personnel have no role in setting or amending the criteria.
607. Deputy Robert Troy asked the Minister for Health if he will expedite an appointment for a person (details supplied). [46653/23]
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.
608. Deputy Seán Haughey asked the Minister for Health if he will provide an update regarding the establishment of the Counsellors and Psychotherapists Registration Board and progress in relation to opening the register; and if he will make a statement on the matter. [46655/23]
View answerAs the Deputy may be aware, the Health and Social Care Professionals Council and Registration Boards, collectively known as CORU, are responsible for protecting the public by promoting high standards of professional conduct, education, training, and competence amongst the professions designated under the Health and Social Care Professionals Act (2005). The Act is being implemented on a phased basis as registration boards and their registers are being established.
Regulations under SI No. 170 of 2018 were made by my predecessor in 2018 to designate the professions of counsellor and psychotherapist under the 2005 Act and to establish one registration board for both professions. Members were appointed to the Counsellors and Psychotherapists Registration Board in February 2019 and they held their inaugural meeting in May 2019.
The work of the Counsellors and Psychotherapists Registration Board (CPRB) includes consideration of the titles to be protected and the minimum qualifications to be required of existing practitioners and the qualifications that will be required for future graduates. The work of the CPRB is significantly more challenging than it is for registration boards for some of the more established professions owing to the different and complex pathways into these professions, the variety of titles used, and the variety and number of courses and course providers.
To date, the following progress has been made by the CPRB:
- Identification, verification and comprehensive assessment of legacy/historical qualifications to determine if they are appropriate for transitioning existing practitioners onto the respective registers (when open);
- Scoping and research on the regulation of counsellors and psychotherapists internationally has been conducted;
- Drafting of separate and distinct Standards of Proficiency for counsellors and psychotherapists and Criteria for Education and Training Programmes has been finalised.
A public consultation on the draft Standards of Proficiency and Criteria for Education and Training Programmes has been launched and will run until 5pm on Friday 1st December 2023. As part of this consultation, the CPRB welcomes feedback from stakeholders, including members of the professions, education providers, employers, professional and representative bodies, as well as members of the public.
Further information on the consultation process is available on the CORU website here: www.coru.ie/public-protection/public-consultations/current-consultations/public-consultation-psychotherapists-standards-of-proficiency-and-criteria-for-education-and-training-programmes-for-psychotherapists.html
609. Deputy Ivana Bacik asked the Minister for Health the position regarding persons who have paid for IVF in respect of the publicly funded scheme; his plans to ensure that such persons are compensated; and if he will make a statement on the matter. [46659/23]
View answerAs the Deputy may be aware, a commitment to “introduce a publicly funded model of care for fertility treatment” is included in the Programme for Government.
The Model of Care for Fertility was developed by the Department of Health in conjunction with the HSE’s National Women & Infants Health Programme in order to ensure that fertility-related issues are addressed through the public health system at the lowest level of clinical intervention necessary.
This Model of Care comprises three stages, starting in primary care (i.e., GPs) and extending into secondary care (i.e., Regional Fertility Hubs) and then, where necessary, tertiary care (i.e., IVF (in-vitro fertilisation) and ICSI (intra-cytoplasmic sperm injection)), with patients being referred onwards through structured pathways.
Phase One of the roll-out of the Model of Care has involved the establishment, at secondary care level, of Regional Fertility Hubs within maternity networks, to facilitate the management of a significant proportion of patients presenting with fertility-related issues at this level of intervention without the need to undergo invasive IVF or ICSI treatment. Patients are referred by their GPs to their local Regional Fertility Hub, which provides a range of treatments and interventions, including: relevant blood tests, semen analysis, assessment of tubal patency, hysteroscopy, laparoscopy, fertility-related surgeries, ovulation induction and follicle tracking. All six Regional Fertility Hubs are currently operational.
Phase Two of the roll-out of the Model of Care relates to the introduction of AHR treatment, including IVF, provided through the public health system at tertiary level. In particular, the first steps have been taken towards achieving the ultimate objective of Government, which is a wholly publicly-provided fertility service.
As an interim measure, I instructed that some funding be made available to support access to advanced AHR treatment via private providers from September 2023. As well as IVF and ICSI, this allocation is also being used to provide, initially through private clinics, IUI (intrauterine insemination), which can, for certain cohorts of patients, be a potentially effective, yet less complex and less intrusive treatment.
Referrals for AHR treatment by private providers have commenced in September 2023 after details of how the new initiative would be initially rolled out - including regarding the set of criteria which prospective patients should meet in order to access fully-funded AHR services and the specific services to be initially funded - were agreed by the Department and NWIHP and then brought to Cabinet in July 2023. The criteria were agreed following consultation with experts in the field of reproductive medicine and include limits in respect of the age of the intending birth mother, body mass index (BMI) and the number of children a couple already have. They are very much in keeping with those applied in other jurisdictions, even though in most European countries, for instance, such treatments are only partially funded and require often significant out-of-pocket payments by patients. More details on public fertility services generally, including information on the new publicly-funded AHR treatment initiative, are available from the HSE at: www2.hse.ie/conditions/fertility-problems-treatments/fertility-treatment/
Regarding your query whether the persons who have paid for IVF will be compensated, as indicated above, referrals for publicly-funded AHR treatment for eligible patients from the Regional Fertility Hubs to approved private clinics commenced in the week beginning September 25th 2023. It is important to ensure that patients are clinically determined by a consultant in a Regional Fertility Hub for IVF, ICSI or IUI before being referred for such treatment, having undertaken at the Hub, as appropriate, extensive consultation, assessment, and the types of procedures and interventions outlined above which are available at the secondary care level. Therefore eligible patients who are referred from a Regional Fertility Hub after the “go live” date can avail of the new publicly-funded AHR treatment initiative and there will be no reimbursement for patients who have paid for treatment privately either prior to this date or after this date without having been referred by a Regional Fertility Hub.
It is important to note that a defined list of fertility medicines needed for fertility treatment is covered under the High Tech Arrangements administered by the HSE. Medicines covered by the High Tech Arrangements must be prescribed by a consultant/specialist and authorised for supply to the client’s nominated community pharmacy by the High Tech Hub managed by the Primary Care Reimbursement Service. The cost of the medicines is then covered, as appropriate, under the client’s eligibility, i.e., Medical Card or Drugs Payment Scheme. Given the costs associated with certain fertility medicines, I understand that these schemes can have a material impact on the total cost of AHR treatment for individuals who avail of them. In this regard, according to figures from the HSE, a total of over €40m was spent on what it termed as fertility drugs in 2022.
In addition, there is other support available in that patients who access IVF, or other advanced AHR treatment, privately may claim tax relief on the costs involved under the tax relief for medical expenses scheme.
My Department and the Government are focused, through the full implementation of the Model of Care for Fertility, on ensuring that patients receive care at the appropriate level of clinical intervention and then those requiring, and eligible for, advanced AHR treatment such as IVF will be able to access same through the public health system. The underlying aim of the policy to provide a model of funding for AHR, within the broader new AHR regulatory framework, is to improve accessibility to AHR treatments, while at the same time embedding safe and appropriate clinical practice and ensuring the cost-effective use of public resources.
610. Deputy Ivana Bacik asked the Minister for Health his plans to commence a screening programme for SKID and SMA; his views on the recommendations of the National Screening Advisory Committee in respect of same; the proposed location for a screening laboratory; and his plans to achieve a standard of screening in excess of forty conditions. [46660/23]
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 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 to support this.
In this regard, I am pleased to note that significant progress has been made on expansion of the NBS Programme over the past 18 months. Since May 2022, babies have been screened for nine conditions following a recommendation from 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. This 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 summarise 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.
Additionally, and following a request from NSAC in January 2023, HIQA commenced a HTA process to examine the evidence for the addition of Spinal Muscular Atrophy (SMA) to the NBS Programme. This HTA has now been completed and was considered by NSAC at its most recent meeting on 20 October 2023. I look forward to receiving a recommendation from the Committee based on their consideration of the HTA once it is available.
Concerning the proposed location of the screening laboratory. It is my understanding that complex preparations are required for the move of the Newborn Screening Laboratory to the new National Children’s Hospital site at St James, with maintained service delivery. This process is due to commence during 2024.
I fully agree with calls for the expansion of the NBS Programme to include additional conditions and this will continue to be a key policy objective of mine as Minister. However, it is necessary to highlight that NSAC is an independent expert group that 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 and must be afforded the necessary time to complete.
The addition of any new condition to the NBS programme also requires a substantial amount of programme planning and technical laboratory validation and verification before screening can commence.
My Department is conscious of the constantly changing landscape regarding screening and in coordination with the Committee, holds Annual Calls, which invite all stakeholders, including members of the public, HSE and other medical professionals, to make proposals for the introduction of new population-based screening programmes or changes to existing programmes in Ireland. The Committee plans to launch its third Annual Call later this year, and information, including details on the submission process, will be posted on the Committee's website www.nsaccommittee.gov.ie.
611. Deputy Ivana Bacik asked the Minister for Health his views on maternal deaths during the period 2019-2021; and if he will make a statement on the matter. [46661/23]
View answerMaternal deaths have a devastating impact on the families and communities concerned.
The publication of the fifth Maternal Death Enquiry Ireland report for 2019-2021 this month, has shown many important findings. In particular, while the overall rate of maternal mortality has been stable, there was a tragic increase in the rate of suicide deaths for women during pregnancy and up to 1 year postnatally in this period.
It is vital that our health services take steps to ensure serious adverse events in maternity care, including maternal deaths, are appropriately reviewed and responded to at a national level.
The HSE’s Incident Management Framework was launched in 2018 and updated in 2020. The Framework is applied to the management of individual incidents and is the mechanism for incident investigations in the HSE, including maternal deaths. In line with the HSE’s Incident Management Framework reports relating to service user incidents are personal to the service user and their relevant person(s) and therefore are not generally published.
In addition, funding of €540,000 was provided in Budget 2022 for the establishment of an Obstetric Event Support Team (OEST) within the HSE’s National Women and Infant Health Programme (NWIHP). The OEST provides objective oversight over a specified list of obstetric clinical incidents occurring within Maternity Networks. It ensures that learning can be applied nationally, through engagement with relevant stakeholders, to lead to safer and improved quality of care for patients and families.
Furthermore, I am committed to continue improving much-needed mental health supports for pregnant and postnatal women.
Perinatal mental health disorders are those which complicate pregnancy and the first postnatal year. A key priority under Sharing the Vision, our national mental health policy, is the continued implementation of the Model of Care for Specialist Perinatal Mental Health Services (SPMHS).
The Model of Care for SPMHS was launched in 2017 and is delivered through a hub and spoke model. There are 6 hubs (located in the largest maternity hospitals) and 13 spoke sites. The 6 hub sites have specialist consultant-led multidisciplinary mental health teams including Perinatal Mental Health Midwives. Mental Health care in the spoke sites is provided by Perinatal Mental Health Midwives for women with milder mental health problems and by Liaison Mental Health teams (or General Adult Community Mental teams in their absence) for women with moderate to severe mental illness.
Awareness of Perinatal Mental Health problems has increased substantially within the maternity services since the inception of the Model of Care. All women attending maternity services now receive screening for mental health problems. There is a need to increase public awareness of perinatal mental health problems, not only among women themselves but also among their partners. The SPMHS programme has developed information leaflets on perinatal mental health, which are displayed within the maternity services and available online on the HSE website. Information on postnatal depression and postpartum psychosis is also available to the public on the HSE website. A Perinatal Mental Health App has been developed for staff with a patient App currently in development.
612. Deputy Ivana Bacik asked the Minister for Health the number of drug overdoses in each county in the years 2019 to 2022 and to date in 2023, and the types of drug consumed, in tabular form; and the number of drug overdose deaths in each county in the corresponding timeframe, and the types of drug consumed, in tabular form. [46662/23]
View answerThe Irish National Drug-Related Deaths Index (NDRDI) is an epidemiological database which records cases of death by drug and alcohol poisoning, and deaths among people who use drugs and/or those who are alcohol dependent. The NDRDI is maintained by the Health Research Board (HRB). It is jointly funded by the Department of Health and the Department of Justice.
The NDRDI records data from four sources: the Coroner Service, the Hospital In-Patient Enquiry scheme (HIPE), the Central Treatment List (CTL), and the General Mortality Register (GMR) through the Central Statistics Office (CSO) in order to ensure that the database is complete and accurate. Cases from the different data sources are cross matched on a selection of variables, including name, gender, county of residence, date of birth and date of death. This allows the NDRDI to eliminate duplicates and to maximise the amount of information available on each case recorded on the database.
Poisonings: Deaths directly due to the toxic effect of the consumption of a drug or drugs and/or other substance(s). Other terms used to describe such deaths include overdose, directly drug-related death, and acute drug death. Deaths arising from adverse reactions to prescribed medication taken under medical supervision are not included in the NDRDI.
Non-poisonings: Deaths in individuals with a history of drug dependency or non-dependent abuse of drugs (ascertained from toxicology results and from CTL, medical or coronial records), irrespective of whether the use of the drug was directly implicated in the death. For presentation purposes it is necessary to group these deaths into broad categories.
Detailed information in table format on drugs implicated in drug related deaths can be found at this link: www.hrb.ie/fileadmin/2._Plugin_related_files/Press_releases/2023_press_releases/HRB_Drug_related_deaths_2020_supplementary_tables.pdf
The number of poisoning deaths in 2019 and 2020 by county of where the deceased resided is presented. Please note that county of residence may differ from the county where the incident which lead to the death occurred. Numbers less than 5 are not routinely reported by the NDRDI. Data for 2021 is not yet available.
In 2019 there were 371 poisoning deaths reported (excluding alcohol-only poisonings) and in 2020 there were 409 poisoning deaths reported (excluding alcohol-only poisonings).
Table 1 Poisoning deaths (excluding alcohol only) by the county where deceased resided, NDRDI 2019 to 2020 (see below link)
