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Wednesday, 15 Nov 2023

Written Answers Nos. 144-158

Mental Health Services

Questions (144)

Claire Kerrane

Question:

144. Deputy Claire Kerrane asked the Minister for Health if he will provide an update on CAMHS services in the State; if he will outline his engagement with an organisation (details supplied) following its submission which includes case studies outlining issues around availability of services for children with intellectual disabilities, extensive waiting times, and lack of early supports for children with ADHD; and if he will make a statement on the matter. [50097/23]

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Written answers

Year on year funding for mental health services increased by €74 million from €1.221 billion announced in Budget 2023 to nearly €1.3 billion in 2024, and with a strong focus on investing in youth mental health. CAMHS receives €137 million in dedicated funding annually. In addition, around €108m has been provided to community-based mental health organisations this year, with a significant proportion dedicated to supporting young people.

As is the case following the Budget each year, the Department of Health is undertaking detailed discussions with the HSE to finalise the Mental Health element of the new HSE Service Plan 2024. Examples of service initiatives under Budget 2024 for Mental Health include:

• Additional staffing for CAMHS teams to improve access to services and reduce waiting lists.

• Expansion of multi-disciplinary CAMHS Hubs Teams to complement traditional service models.

• Further development of specialist mental health teams providing essential services.

• A new Youth Mental Health app.

• Development of a central referral mechanism (‘No wrong door’) for services for children, to be established on a pilot basis within the HSE to make referrals to community children's services including CAMHS easier to navigate and to ensure no child is waiting on the wrong list.

Representatives from the organisation referred to by the Deputy had a meeting with officials from the Department of Health and the Health Service Executive on 15 September 2023. Separately, I then met with the organisation on 25 October 2023.

Both meetings proved useful and constructive overall where broad issues of mutual interest were discussed to improve the delivery of youth mental health services, including Early Intervention services and improving links by the specialist HSE Child and Adolescent Mental Health Service with other relevant care programmes.

The Deputy can rest assured that I, and the HSE, will continue to liaise as appropriate with this organisation in relation to improving youth mental health care overall.

Hospital Waiting Lists

Questions (145)

Michael Ring

Question:

145. Deputy Michael Ring asked the Minister for Health if an ICU bed could be ringfenced for a specific purpose (details supplied) in light of the number of children currently waiting for a procedure; and if he will make a statement on the matter. [50127/23]

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Written answers

I acknowledge that waiting lists and times for scoliosis and spina bifida services are unacceptably long. I am acutely conscious of the burden that this places on patients and their families.

I have committed €19 million under the 2022 and 2023 Waiting List Action Plans to tackle these waiting lists. To date this has meant an additional 193 health care professionals across Temple Street, Crumlin and Cappagh, including nurses, consultant doctors, anaesthesiologists, and radiographers.

We are in the middle of bringing on board significant capacity including a 5th theatre which is now open in Temple Street, an additional MRI is operational in Crumlin, and 24 additional beds, of which 20 are already open.

In 2022, 509 spinal procedures were carried out, compared to 380 for the same period in 2019. This year to date over 370 spinal procedures were completed.

So, while waiting lists remain far too long, it is fair to acknowledge that there is an increase in the number of patients being treated.

I met with the HSE Chief Executive, the HSE, CHI, and orthopaedic surgeons on this matter. My Department and the HSE are working hard to make progress in this area including improvements to the organisation, management, and delivery of the services.

Health Services Staff

Questions (146)

Cian O'Callaghan

Question:

146. Deputy Cian O'Callaghan asked the Minister for Health further to Parliamentary Question No. 1229 of 7 November 2023, if there is an estimated timeframe for when pay parity will be delivered for medical scientists; and if he will make a statement on the matter. [50129/23]

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Written answers

Firstly, I would like to acknowledge the dedication, professionalism, and commitment of all Medical Scientists throughout the country.

I am very conscious of the MLSA's long-standing claim for pay parity with Clinical Biochemists. Following productive talks at the Workplace Relations Commission back in May and June of 2022, agreement was reached to conduct an independent assessment of the role, responsibilities and pay of medical laboratory scientist grades. This assessment was undertaken by an independent assessor and the final report issued in January 2023.

Following the issuing of this report, my officials in the Department of Health, along with colleagues in the HSE and the Department of Public Expenditure, NDP Delivery and Reform, have continued to engage with the MLSA on this matter under the auspices of the industrial relations machinery of the State.

As this is an Industrial Relations matter, I am not in a position to comment in relation to a timeline for resolution at this point. However the parties remain in an IR process under the auspices of the state’s industrial relations machinery and have been working hard to resolve this matter.

Primary Medical Certificates

Questions (147)

Jackie Cahill

Question:

147. Deputy Jackie Cahill asked the Minister for Health if persons (details supplied) can be provided with an assessment for a primary medical certificate on a certain date; when the next round of assessments are taking place; and if he will make a statement on the matter. [50133/23]

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Written answers

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

The Deputy may be aware, management and administrative grade staff in the Fórsa union in the HSE commenced industrial action on Friday 6th  October. As a consequence of this industrial action, members in these grades are not engaging with political forums or processes. As a result, the question asked by the Deputy may be delayed in receiving a response directly from the HSE. 

Departmental Inquiries

Questions (148)

Rose Conway-Walsh

Question:

148. Deputy Rose Conway-Walsh asked the Minister for Health for an update regarding the appointment of an independent chairperson to the sodium valproate inquiry; the reason why a chairperson has not been appointed to date; when he expects the chairperson to be in place and for the inquiry to begin; and if he will make a statement on the matter. [50139/23]

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Written answers

When I met with the patient groups involved with this issue, I supported their call for an inquiry into sodium valproate and I committed to making that happen. I was delighted to secure Government approval for the establishment of an inquiry which will examine the licensing and use of sodium valproate in women of child-bearing potential in the State. I am very pleased to be able to progress this. This inquiry will be designed to give a voice to patients and their families while looking at the use of sodium valproate in Ireland since it was first licensed.

Work is actively ongoing in my Department in relation to sourcing an appropriate person to Chair the inquiry, and the Deputy will appreciate that this is a sensitive matter. The Chair is an essential role that needs careful consideration. The role requires and experienced person who will run a fair and independent process, and who can give the inquiry the time and attention it deserves.

There is more work to be done to establish the inquiry It is important that enough time and resources are invested in completing this work. There are many factors to consider, and I want to ensure that the inquiry established delivers and allows those impacted to tell their story and my officials are working to ensure that this will be facilitated.

I will be glad to provide an update on this matter once this work is finalised.

Disease Management

Questions (149)

Róisín Shortall

Question:

149. Deputy Róisín Shortall asked the Minister for Health the reason why epilepsy is not listed under the HSE Chronic Disease Management Programme; the process required to have the condition recognised under the programme; and if he will make a statement on the matter. [50153/23]

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Written answers

Under the GMS scheme, the HSE contracts GPs to provide medical services without charge to medical card and GP visit card holders. The General Practitioner (GP) Chronic Disease Management (CDM) Programme commenced in 2020 and has been rolled out on a phased basis to adult GMS (Medical Card and GP Visit Card) patients over a 4-year period. The specified chronic conditions included in the Programme are Type 2 Diabetes; Asthma; Chronic Obstructive Pulmonary Disease (COPD) and Cardiovascular Disease (including Heart Failure, Ischaemic Heart Disease, Cerebrovascular Disease (Stroke/Transient Ischemic Attack (TIA), Atrial Fibrillation).

The CDM programme represents a new approach in Ireland to working with patients to manage their healthcare.  It has brought the care for chronic disease further into the community and closer to the patient, and over time is expected to reduce hospital attendance by patients with one or more of the specified conditions.

Further expansion of the programme to include additional conditions would require rigorous clinical assessment and engagement with stakeholders, including the GPs delivering the service.  Nonetheless, this could be considered in the future in the context of resource availability.

Health Service Executive

Questions (150)

Róisín Shortall

Question:

150. Deputy Róisín Shortall asked the Minister for Health if the Health Service Executive pensions section in Manorhamilton is now fully staffed and in a position to process all pension matters for retired HSE workers in a swift and timely manner; if not, if he will outline the steps being taken to address this; and if he will make a statement on the matter. [50154/23]

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Written answers

As this Parliamentary Question relates to an administration 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.

Hospital Appointments Status

Questions (151)

Robert Troy

Question:

151. Deputy Robert Troy asked the Minister for Health f he will expedite an appointment for surgery for a person (details supplied). [50196/23]

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Written answers

Under the Health Act 2004, the Health Service Executive (HSE) is required to manage and deliver, or arrange to be delivered on its behalf, health and personal social services. Section 6 of the HSE Governance Act 2013 bars the Minister for Health from directing the HSE to provide a treatment or a personal service to any individual or to confer eligibility on any individual.

In relation to the particular query raised, as this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.

As the Deputy may be aware, management and administrative grade staff in the Fórsa union in the HSE commenced industrial action on Friday 6th October. As a consequence of this industrial action, members in these grades are not engaging with political forums or processes. As a result, the question asked by the Deputy may be delayed in receiving a response directly from the HSE. 

Medical Cards

Questions (152)

Marian Harkin

Question:

152. Deputy Marian Harkin asked the Minister for Health further to Parliamentary Question No. 1328 of 7 November 2023, if treatment for retrograde cricophalyngeas dysfunction (R-CPD) will be made available on the medical card; and if he will make a statement on the matter. [50226/23]

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Written answers

The Health Act 1970 (as amended) provides for two categories of eligibility for persons ordinarily resident in the country, i.e. full eligibility (medical card holders) and limited eligibility (all others).

People with full eligibility (medical card holders) can currently access a range of services including GP services, prescribed drugs and medicines, public in-patient hospital services, including consultants’ services, out-patient public hospital services including consultants’ services, dental, ophthalmic and aural services and appliances, and maternity and infant care service. The issue of granting medical or GP visit cards based on having a particular disease or illness was previously examined in 2014 by the HSE Expert Panel on Medical Need and Medical Card Eligibility. The Group concluded that it was not feasible, desirable, nor ethically justifiable to list medical conditions in priority order for medical card eligibility. In following the Expert Group’s advice, a person’s means remains the main qualifier for a medical card. Medical Card provision is primarily based on financial assessment. In accordance with the Health Act 1970 (as amended), eligibility for a medical card is determined by the HSE, which assesses each application on a qualifying financial threshold.

However, every effort is made by the HSE, within the framework of the legislation, to support applicants in applying for a medical card and, in particular, to take full account of the difficult circumstances in the case of applicants who may be in excess of the income guidelines. The HSE may exercise discretion and grant a medical card, even though an applicant exceeds the income threshold where they face difficult financial circumstances, such as extra costs arising from an illness. Social and medical issues are also considered when determining whether undue hardship exists for an individual accessing general practitioner or other medical services.

As this is a service matter it has been referred to the Health Service Executive for direct reply to the Deputy.

Insurance Coverage

Questions (153)

Jim O'Callaghan

Question:

153. Deputy Jim O'Callaghan asked the Minister for Health the number of persons availing of private health insurance, by age group (details supplied). [50229/23]

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Written answers

The Minister thanks the Deputy for his question. The number of persons availing of private health insurance, by age group, is detailed in the following table: 

 Age

Insured Population as at 1 July 2023

0-17

527,570

18-29

298,129

30-39

308,162

40-49

374,389

50-59

321,863

60-69

265,875

70-79

192,232

80+

89,058

Total

2,377,278

General Practitioner Services

Questions (154)

Violet-Anne Wynne

Question:

154. Deputy Violet-Anne Wynne asked the Minister for Health his views on the long-term sustainability of GP services in County Clare in view of an ageing population; and if he will make a statement on the matter. [50283/23]

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Written answers

GPs are self-employed practitioners and therefore may establish practices at a place of their own choosing. There is no prescribed ratio of GPs to patients and the State does not regulate the number of GPs that can set up in a town or community.

Under the GMS scheme, the HSE contracts GPs to provide medical services without charge to medical card and GP visit card holders. Currently, there are 2,533 GPs contracted to provide services under the GMS Scheme. Where a vacancy arises in a practice with a GMS contract, the HSE becomes actively involved in the recruitment process to find a replacement GP. As of the 1st November, there are two GMS GP vacancies in County Clare.

For GMS patients unable to locate a GP themselves, the Health Service Executive may assign an eligible person to be included on a medical practitioner's GMS list, in accordance with the GMS contract.

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 help make general practice in Ireland a more attractive career choice for doctors and will see an increase in the number of GPs working in the State, improving access to GP services for patients throughout the country. Figures recently released by the ICGP show that 1,311 medical graduates have applied for GP training in 2024, a notable increase on last year and higher than any previous years.

The number of doctors entering GP training has been increased in recent years, with 286 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. 

Lastly, my Department and the HSE have commenced a Strategic Review of General Practice. The review, with input from key stakeholders, will examine the broad range of issues affecting general practice, including issues related to GP capacity, and will set out the measures necessary to deliver a more sustainable general practice into the future.

General Practitioner Services

Questions (155)

Violet-Anne Wynne

Question:

155. Deputy Violet-Anne Wynne asked the Minister for Health what measures are being taken to actively recruit GPs to come and work in rural practices from outside of Ireland; and if he will make a statement on the matter. [50284/23]

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Written answers

In cooperation with my Department, the HSE and the ICGP introduced this year a non-EU Rural GP Programme which is on target to bring 100 additional non-EU GPs into the State. These GPs work in GP practices providing healthcare to patients, and will, on successful completion of the 2-year programme, be eligible to practice independently and take up a GMS contract. The programme targets the placement of GPs to rural and urban deprived areas with limited GP access for patients. It is planned to bring to Ireland up to 250 more non-EU GPs by the end of 2024. 

All doctors wishing to practice in Ireland must be registered with the Medical Council. The Council has established processes for the assessment of both general and specialist medical qualifications from Ireland, EEA and third countries.

The non-EU GP programme compliments the increases made in recent years to the number of doctors entering GP training, which has risen to 286 this year with 350 places for new entrants planned for next year. Annual intake to the GP training scheme has been increased by over 80% since 2015.

The Government has taken measures to increase the attractiveness of general practice in Ireland as a career for doctors. Figures recently released by the ICGP show that 1,311 medical graduates have applied for GP training in 2024, a notable increase on last year and higher than any previous years. 

Under the 2019 GP Agreement additional annual expenditure provided for general practice has been increased now by €211.6m. The Agreement provides for an increase in capitation fees for participating GPs, additional services, improved family arrangements as well as a targeted €2 million fund to support to practices in deprived urban areas. The recent GP Agreement 2023 announced in July, 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.

Specific supports are in place to support GPs in rural areas. The practice support package for rural GP practices which was introduced previously was increased by 10% under the 2019 GP Agreement. Practices in receipt of rural practice supports attract the maximum allowable rates for practice staff support subsidies and locum contributions for leave taking. Specific fees are also in place for dispensing doctors (who operate in rural areas), these have been increased by 28% under that Agreement.

In addition, as part of the GP Agreement 2023, a ring-fenced fund of €0.6m is being made available to support the delivery of initiatives to support rural GPs, including assistance sourcing locum cover for leave taking. The HSE will collaborate with the IMO to implement these supports.

Lastly, my Department and the HSE have commenced a Strategic Review of General Practice. The review, with input from key stakeholders, will examine the broad range of issues affecting general practice, including issues related to GP capacity, and will set out the measures necessary to deliver a more sustainable general practice into the future. The provision of GP services in certain rural and urban deprived areas that are underserved, and the possible mechanisms to attract more GPs to these locations, is a specific issue that will be examined under the review.

Building Regulations

Questions (156)

Mairéad Farrell

Question:

156. Deputy Mairéad Farrell asked the Minister for Further and Higher Education, Research, Innovation and Science if, in relation to the Construction Safety Licensing Bill 2023, which is partly intended to replace the current accredited training model (details supplied), he can confirm that following the passing of this Bill, the QSCS and CSCS training accreditation will be de-certified; and if he will make a statement on the matter. [50049/23]

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Written answers

The Construction Safety Licensing Bill 2023 provides for a new and comprehensive framework for the licensing of certain construction, quarrying and related activities in Ireland.

Following an independent review of SOLAS’s Construction Services Unit in 2017 and subsequent consultation with public sector, industry, and staff representatives, all stakeholders agreed that the recommendations of the review would be adopted, including moving to a licensing system for certain construction and quarrying activities.

Awarding of the CSCS and QSCS cards is linked to QQI certification. However, unlike a lifelong educational qualification, the CSCS and QSCS schemes relate to evidence of a cardholder’s skills to complete a task in a manner that does not put others or themselves at risk. These skills need to be kept current and are therefore better suited to a licensing type model, which would include formal renewal and Competency Professional Development processes.

As outlined in the draft Bill that was amended at Committee Stage in May 2023, activities that are currently covered by CSCS and QSCS and administered by QQI as certificates for life, will move to a new licensing model under the Bill.

The Bill, once enacted, will provide for the establishment of a licensing authority to oversee the new licensing model, including the renewal and reassessment of licences for workers and tutors. This will replace the current QQI accreditation model.

A transition period will be in place for those who currently hold CSCS or QSCS cards. It is proposed that a CSCS and QSCS card will remain valid for a period of 5 years beginning from when the relevant section in the Bill is enacted or until the card’s expiry date, whichever is the earlier, and a person must then apply for a licence to replace this card.

The most recent version of the Bill, as amended at Committee Stage, can be found here: data.oireachtas.ie/ie/oireachtas/bill/2023/24/eng/ver_a/b24a23d.pdf.

Departmental Bodies

Questions (157)

Eoin Ó Broin

Question:

157. Deputy Eoin Ó Broin asked the Minister for Rural and Community Development what appointment procedure she is using for the new stakeholder group on dog ownership in Ireland; and the measures she is putting in place to ensure that members of the group will include expertise in canine behaviour. [50064/23]

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Written answers

In late 2022, Minister Mc Conalogue was tasked by the then Taoiseach, now Tánaiste Micheál Martin to lead a cross-government review of legislation regarding dogs. I met with Minister Mc Conalogue on Monday 9th January and we requested officials to convene a working group on the control of dogs’ issue. This group, which was chaired by DAFM, produced a report in March. I was pleased to recently announce significant progress in the implementation of recommendations assigned to my Department.

On 9th November, I signed Statutory Instrument 540 of 2023 to increase on-the-spot fines for offences under the Control of Dogs Acts 1986 to 2014, including introducing a graduated fine system, and trebling fines for serious offences from €100 to €300.

I also announced the establishment of a high-level stakeholder group to provide a forum for stakeholder organisations to express their views on issues and possible solutions related to dog control issues. The issue of restricted dog breeds and possible amendments or changes to the current arrangements will be discussed by this group, in order to inform policy development in this area.

The group will be independently chaired and encompass a broad range of sectoral interests and expertise. Details of the membership and terms of reference will be made available on Gov.ie subject to agreement by the chair and the group in due course.

In addition to these measures, I also announced €2 million in capital funding to support Local Authority Dog Control Services and assist them in meeting increased demands on their services.

Departmental Bodies

Questions (158)

Cian O'Callaghan

Question:

158. Deputy Cian O'Callaghan asked the Minister for Rural and Community Development if she will provide the terms of reference for the high-level stakeholder group for dog control; the membership of this group; and if she will make a statement on the matter. [50130/23]

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Written answers

In late 2022, Minister Mc Conalogue was tasked by the then Taoiseach, now Tánaiste Micheál Martin to lead a cross-government review of legislation regarding dogs. I met with Minister Mc Conalogue on Monday 9th January and we requested officials to convene a working group on the control of dogs’ issue. This group, which was chaired by DAFM, produced a report in March.

I was pleased to recently announce significant progress in the implementation of recommendations assigned to my Department.

On 9th November, I signed Statutory Instrument 540 of 2023 to increase on-the-spot fines for offences under the Control of Dogs Acts 1986 to 2014, including introducing a graduated fine system, and trebling fines for serious offences from €100 to €300.

I also announced the establishment of a high-level stakeholder group to provide a forum for stakeholder organisations to express their views on issues and possible solutions related to dog control issues. The issue of restricted dog breeds and possible amendments or changes to the current arrangements will be discussed by this group, in order to inform policy development in this area.

The group will be independently chaired and encompass a broad range of sectoral interests and expertise. Details of the membership and terms of reference will be made available on Gov.ie subject to agreement by the chair and the group in due course.

In addition to these measures, I also announced €2 million in capital funding to support Local Authority Dog Control Services and assist them in meeting increased demands on their services.

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