Written Answers Nos. 316-325
316. Deputy Brendan Griffin asked the Minister for Health if he will examine the current levels of GP cover on the Iveragh Peninsula; if he will formulate a plan to address the shortage of GPs in the area; if he will provide incentives for GPs to locate to the area; and if he will make a statement on the matter. [2270/24]
View answerGPs 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 2,518 GPs contracted to provide services under the GMS Scheme.
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 has undertaken several measures to increase the number of GPs working across the country and thereby improve access to GP services for all patients. The 2019 GP Agreement provided for increased annual investment of over €211 million for general practice, providing for increased GMS GP fees, supports and new services. In particular the 2019 Agreement increased the enhanced supports package for rural GP practices by 10%. A further €30 million has been provided for under the GP Agreement 2023 for practice supports to expand and retain practice staff.
The annual intake of doctors into the GP training programme has been increased by 80% from 2015 to 2023; there were 286 new entrants to GP training in 2023 and it is planned to increase the number of places for new entrants to 350 for this year. Furthermore, the joint HSE ICGP non-EU Rural GP Programme commenced last year with the intention of bring up to 100 non-EU GPs to Ireland in 2023, and it is planned to bring up to 250 more non-EU GPs here by the end of this year.
The Strategic Review of General Practice, which is currently underway, is examining the broad range of issues affecting general practice, including issues related to GP capacity and the consideration of mechanisms to attract GPs to rural and urban deprived areas. When completed, the review will set out recommendation actions to deliver a more sustainable general practice into the future.
In relation to the level of GP services available on the Iveragh Peninsula, as this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly with an update.
As the Deputy may be aware, management and administrative grade staff in the Fórsa union in the HSE commenced industrial action on Friday, 6 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.
317. Deputy Brendan Griffin asked the Minister for Health if he will examine the current practice at UHK where patients in the ED are moved on trolleys to wards when the trolley count reaches 20; if he can outline who sanctioned this practice; when it began; what the rationale is for this practice; what impact this is having on patient outcome; and if he will make a statement on the matter. [2271/24]
View answerAs this is a service matter, I have asked the HSE to respond to the deputy directly.
318. Deputy Brendan Griffin asked the Minister for Health what progress he has made on ensuring that small private independent nursing homes can remain viable into the future; if he will address the lack of parity in the system in respect of subsidies provided to private and public establishments; if he acknowledges that there is unfairness built into the current system; and if he will make a statement on the matter. [2272/24]
View answerThe Government is conscious of the financial challenges faced by the nursing home sector, especially smaller and voluntary nursing homes that may not have access to the same economies of scale as larger homes or groups.
To that end the Government has provided substantial support to the private and voluntary nursing home sector over the pandemic. Over €151m of financial support has been provided to private and voluntary nursing homes through the COVID-19 Temporary Assistance Payment Scheme (TAPS). The provision of free PPE and oxygen to private nursing homes continues, costing approximately €77 million to date. A €10 million scheme (TIPS) was established in 2022 to support private and voluntary nursing homes with increases in energy costs, covering 75% of year-on-year cost increases up to a monthly cap of €5,250 per nursing home. This scheme was extended for a second time to the end of June 2023.
Budget 2023 saw over €40 million in additional funding for the Nursing Homes Support Scheme (NHSS or Fair Deal) which is providing for an uplift in the maximum prices chargeable by private and voluntary nursing homes, as negotiated.
Anyone who has had a scheduled renegotiation of their Deed of Agreement this year with the National Treatment Purchase Fund (NTPF) has seen a significant uplift (an average baseline increase in price per bed of 6%)
The budget to support 22,800 people to live in nursing homes through Fair Deal is approximately €1.5 billion this year.
An additional €45.6 million has been allocated to support nursing homes in Budget 2024, including a new €10 million fund to support private and voluntary nursing homes with HIQA compliance. The new scheme is designed to target and support structural improvements in nursing homes to assist their meeting HIQA compliance plans in respect of protection against infection and fire precautions. This is active as from 1 January 2024 and can be backdated for eligible works to 1 January 2020.
The Department of Health acknowledges that there are differences in the cost of care between public and private nursing homes. Maximum prices for individual nursing homes are agreed with the National Treatment Purchase Fund (NTPF) following negotiations and based on the NTPF’s cost criteria such as costs reasonably incurred by the nursing home, local market prices, historic prices and overall budgetary capacity. The NTPF has statutory independence in this process.
Rates for public nursing homes are set based on historic costs and available resources, according to a list of eligible expense categories agreed by the Oireachtas.
The cost for the resident does not change whether they are in a public or a private home.
The Value for Money (VFM) review published in 2021 report clearly showed that this cost differential is driven by a higher level of staffing in public nursing homes, with a higher nursing ratio per resident and a different skill mix to private nursing homes. The HSE is staffed at a level that allows delivery of more complex care where required, according to its responsibility as provider of last resort.
The review made 9 recommendations, including agreement of the safe staffing and skill mix framework, rollout of the InterRAI tool for assessing dependency, and a review and audit of certain public nursing homes. The Department of Health continues to take these forward.
319. Deputy Brendan Griffin asked the Minister for Health the current position regarding the future use of the Saint Finan's Hospital site and buildings in Killarney; what recent approaches have been made to the HSE regarding the property; and if he will make a statement on the matter. [2273/24]
View answerAs the Health Service Executive is responsible for the management of the public healthcare property estate, I have asked the HSE to respond directly to you in relation to this matter.
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.
320. Deputy Violet-Anne Wynne asked the Minister for Health the total complement of off-shift staff accommodation at a University of Limerick hospital group; and if he will make a statement on the matter. [2276/24]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly.
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.
321. Deputy Paul Kehoe asked the Minister for Health if all refugee children have the same access to health services as children who are Irish citizens, that is CAMHS, dental services and so on; and if he will make a statement on the matter. [2291/24]
View answerAccess to health services for those who are ordinarily resident in Ireland is based on a determination of eligibility in accordance with the Health Act 1970 (as amended). This is primarily based on a financial assessment which is conducted by the Health Service Executive (HSE) upon receipt of the relevant application. Further information can be found at: www2.hse.ie/services/schemes-allowances/medical-cards/applying/apply/.
Individuals with eligibility for a medical card can access a range of services including General Practitioner (GP) services, prescribed drugs and medicines on the HSE reimbursement list, all in-patient public hospital services in public wards, including consultant services, all out-patient public hospital services including consultant services, dental, ophthalmic, and aural services, aids and appliances, and maternity and infant care services.
For those not eligible for a medical card, a GP visit card provides for visits to a participating GP service without fees and also covers visits to GP out-of-hours service. All children under 8 years of age living in Ireland can get a GP visit card, which provides:
• free GP visits
• assessments at age 2 and 5
• out-of-hours urgent GP care
• care for children with asthma
Further information can be found at: https://www2.hse.ie/services/schemes-allowances/gp-visit-cards/under-8s/.
Those without eligibility for a medical card can benefit from other community drug schemes. For example, 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. Further information can be found at: https://www2.hse.ie/services/schemes-allowances/drugs-payment-scheme/apply/.
322. Deputy Bernard J. Durkan asked the Minister for Health to indicate if and when cataracts treatment might be made available to a person (details supplied); if the details of the national treatment purchase scheme can be invoked as a matter of urgency; and if he will make a statement on the matter. [2312/24]
View answerThe National Treatment Purchase Fund (NTPF) works with public hospitals, as opposed to with patients directly, to offer and provide the funding for treatment to clinically suitable long waiting patients who are on an Inpatient/Day case or Outpatient waiting list.
The key criteria of the NTPF is the prioritisation of the longest waiting patients first. While the NTPF identifies patients eligible for NTPF treatment, it is solely on the basis of their time spent on a waiting list. The clinical suitability of the patient to avail of NTPF funded treatment is determined by the public hospital.
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.
323. Deputy Bernard J. Durkan asked the Minister for Health to indicate the current position in regard to provision of medical cards for persons (details supplied); and if he will make a statement on the matter. [2316/24]
View answerAs 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.
324. Deputy Bernard J. Durkan asked the Minister for Health the extent to which women’s health specifically remains central to the provision and delivery of a reliable level and quality of health services in all areas throughout Ireland without exception; and if he will make a statement on the matter. [2321/24]
View answerProgressing women’s health is a priority for myself and for this Government. We made a strong commitment to promoting women’s health in the Programme for Government 2020 and are fully committed to the continued development and improvement of women’s health services and to working with women and girls to improve their health outcomes and experiences of healthcare across the whole life cycle.
Underscoring our commitment to women’s health was the establishment of a Women’s Health Taskforce in September 2019. The Women’s Health Taskforce, which includes representation from the National Women’s Council of Ireland and the European Institute of Women’s Health, continues to prioritise different issues each year with the overall aim of improving women’s health outcomes and experiences. Critical to this work is the process of listening to women - the Taskforce has so far listened to, engaged with and worked with thousands of women and hundreds of organisations representing women and girls across the country. The Taskforce commits to continued listening, remaining informed of women’s experiences of health and the healthcare system and working to respond as issues arise.
The Women’s Health Action Plan 2022-23 was published on 8 March 2022, marking International Women’s Day. The Action Plan identifies key actions to improve health outcomes and experiences for women in Ireland. It provides the foundation to address women’s whole health and help ensure that action on women’s health looks beyond reproductive health to make a real difference to women’s lives. I can assure the Deputy that Women’s Health continues to be one of my priorities going forward into 2024 and beyond.
Alongside the Women’s Health Action Plan, significant investment has been made into women’s health since the formation of this government. This has enabled the action plan to be delivered effectively.
We have seen significant investment in the area of women’s health. Budget allocations since 2021 for new developments for specific women’s health measures:
• 2024: €1.47 million
• 2023: €26.8 million
• 2022: €31 million
• 2021: €17 million
• Prioritisation of women’s health in our service provision is seen in the completed and ongoing work happening to improve healthcare for women across the country. There have been a number of key developments since the establishment of the Women’s Health Taskforce and the Women’s Health Action Plan 2022-23.
• Contraception: The free contraception scheme for women was launched in September 2022, initially for those aged 17-25. The scheme has been gradually expanded to include women aged 31 and under, as of 1st January 2024. Funding allocated to support the scheme is approximately €43.9m in 2024. Approximately 2,400 GPs, primary care and student health centres and family planning clinics, and 2,050 pharmacists are providing services under the scheme, across the country.
• Menopause: 6 Specialist Menopause Clinics to treat complex symptoms of Menopause, all of which are open and operational. A GP Quick Reference Guide on Menopause was launched by the ICGP in October 2022 to support primary care practitioners in treating menopause and referring patients to Specialist Clinics. The National Menopause Awareness Campaign (Radio, Online, Print, TV) was launched in two phases by the Department of Health to raise awareness and “lift the taboo” around menopause. Gov.ie/menopause was launched as a one-stop shop for information about menopause and its symptoms as well as advice on proactive management. VAT was removed from HRT in Budget 2023.
• Fertility: 6 Regional Fertility Hubs have been established to provided tailored, low-level intervention for patients referred by GPs with fertility-related issues. Many of these patients will be managed in these Hubs without the need to undergo invasive IVF or ICSI treatment. Investment to support publicly funded Assisted Human Reproduction (AHR) treatment has also been allocated and will see the first National AHR Centre established. As an interim measure, funding has been made available to enable eligible patients to access AHR treatment via private providers. This historic, a new initiative means that public patients are now being referred for AHR treatment which is to ‘go live’ since week commencing 25th September 2023.
• Gynaecology: A network of 20 “see and treat” ambulatory gynaecology clinics are in development, where an estimated 70% of general gynaecology referrals are suitable for management. 15 Ambulatory Gynae Clinics are currently open and operational, with additional clinics in development. The national network will improve access to services; help to reduce the requirement for multiple gynaecology appointments; help to ensure sustainability of service provision into the future given the significant waiting lists for this specialty; and will help improve clinical outcomes. Approximately 2,900 clinics were held providing care to an estimated 16,000 women in 2023.
• Maternity: Implementation of the National Maternity Strategy (2016-2026) is ongoing, consolidating progress made through €16m strategy funding allocated in 2021 and 2022. This has included further embedding the Strategy’s Model of Care in all 19 maternity units, increased access to community midwifery services (including through the opening of 5 postnatal hubs), improvement of infrastructure (including through additional home-from-home birthing suites, and upgrades to theatres and wards), the establishment of a National Perinatal Genomics Service (ensuring women across the country have access to critical testing both during their pregnancy, and in planning for future pregnancies), establishing an updated national antenatal education curriculum, and strengthening training and supports for maternity staff.
• Termination of Pregnancy Review: Review of the operation Health (Regulation of Termination of Pregnancy) Act 2018 commenced in line with statutory and Government commitments in December 2021. The final Report of the Review was considered by Cabinet on 25 April 2023. The Government agreed that an implementation group would be established by the HSE to progress the operational recommendations. Significant progress is being made in respect of various recommendations in the Report. The proposals in the Report recommending legislative changes to the 2018 Act were referred to the Joint Committee on Health for consideration. The JCH report received and is being considered. By the end of 2023 17 of 19 maternity hospitals were providing full termination of pregnancy services, as prescribed in the 2018 Act, which includes Termination of Early Pregnancy (i.e., under 12 weeks).
• Safe Access Zones: I secured Cabinet approval to legislate for the designation of safe access zones around healthcare premises to safeguard access to termination of pregnancy services in July 2022 and published the General Scheme of the Health (Termination of Pregnancy Services (Safe Access Zones) in August 2022. Since that time officials have worked with the Office of the Attorney General and other relevant stakeholders to draft the text of a bill. This Bill was published at the end of June 2023 and initiated in the Houses in early July 2023. Legislation providing for Safe Access Zones has completed final stage in the Dail and is currently awaiting committee stage in the Seanad.
• Mental Health: The Women’s Health Fund provided investment in 2022 to support a range of services for women and girls, including digital mental health services access, improving perinatal mental health supports, enhancing specialist eating disorder supports, providing targeted mental health supports for marginalised women and women in addiction and responding to the needs of young girls at risk of developing psychosis. In 2023 the Women’s Health Fund provided investment for an initiative to support women in the development of protective factors to build resilience and alleviate mental health difficulties. In March 2023, the Minister for Health launched Embedding Women’s Mental Health in Sharing the Vision – a report by the specialist group on the National Implementation Monitoring Committee (NIMC) Specialist Group on women’s mental health. Work is on-going to implement its recommendations in the delivery of the policy. Work is ongoing on the implementation of the Model of Care for Specialist Perinatal Mental Health Services as a key priority under Sharing the Vision, our national mental health policy. Perinatal mental health services have now been developed in all 19 maternity units/hospitals and provide specialist support to women experiencing mental health difficulties in pregnancy. Perinatal mental health disorders are those which complicate pregnancy and the first postnatal year.
• Physical Activity: The campaign, ‘It’s My Time’, funded by a €300,000 allocation from the Women’s Health Fund and managed by Sport Ireland in collaboration with Healthy Ireland, was run in December 2022 and January 2023, following detailed marketing research on messaging resonating with women in the target demographics. It’s My Time encouraged women to prioritise their wellbeing by getting more physically active on their own terms and in their own time. The campaign ran across digital, video-on-demand, and social media and was supported by various sporting National Governing Bodies and the nationwide network of Local Sports Partnerships.
• Period Poverty: VAT was removed from all period products in Budget 2023. Period poverty funding has been increased to €914,000 in 2024, supporting period dignity measures in partnership with the HSE, community health organisations, local authorities and NGOs. In 2023, HSE supports were provided to all 9 CHOs and the Department funded 22 Local Authorities, 44 Family Resource Centres through the FRCNF and 10 NGOs to provide period dignity supports. The Healthy Ireland Survey, 2022, found that 51% of women currently having periods experience disruption to daily life as a result of pain and other adverse symptoms of periods, and that 24% have experienced indicators of period poverty.
• In addition to the above-mentioned developments, the Women’s Health Fund was established in Budget 2021. The fund responds to the issues that women have asked us to prioritise and align with the Minister’s priorities and the priorities of the Women’s Health Programme.
• The fund, to date, has supported and invested in a range of key service areas across women’s health including cancer screening and immunisation, primary care supports, maternity services and postnatal hubs, gynaecology, mental health and supports for marginalised groups.
• The Health Regions Implementation Plan commits to taking a population-based approach to how health and social care services are planned and funded, an approach which was championed in the Sláintecare Report. Allocation of existing healthcare resources to the Health Regions will be informed by factors such as age, sex, socioeconomic status, and rurality. An Expert Group will shortly be established by the Department to develop this population-based resourcing approach (PBRA). This means that we will be planning services around the health and social care needs of our entire population. The service needs of women are considered as part of this.
• Implementation of the services listed above represents significant development and advancement for women's health nationwide, but this remains a work in progress. I am committed to the full implementation of the Women's Health Action Plans, current and future, and will continue to drive progress in all areas of women's health to give women and girls the health services they deserve.
325. Deputy Bernard J. Durkan asked the Minister for Health to indicate if all resources possible can be made available to ensure all hours allocated under home care packages are being used and fulfilled with particular reference to County Kildare; and if he will make a statement on the matter. [2322/24]
View answerAs this is an operational 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, 6 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
