Written Answers Nos. 1461-1484
1461. Deputy Bernard J. Durkan asked the Minister for Health the steps his Department is taking to ensure a focus remains on ensuring Irish patients have timely access to rare disease treatments (details supplied) and if he will make a statement on the matter. [12779/24]
View answerMy ambition is to deliver greater access for patients, including patients with a rare disease, to the latest innovative medicines.
In 2023, over €3.2 billion was spent on medicines by the State. This represents nearly €1 in every €8 of public funding being spent on health. Over the last 3 years the State has invested €98 million in new medicines, providing 148 new medicines or extended uses for medicines, including 39 medicines with an orphan designation. €98 million represents only the initial cost of these medicines. The spending on these medicines is estimated at €327.5 million to the end of 2023.
The HSE will have €30 million to spend on new drugs in 2024. This comprises €20 million of new development funding and a further €10 million, to be generated through HSE efficiencies, which will also be re-invested in new drugs. This ensures that the substantial investment in medicines is maximised to treat even more patients with new innovative therapies in the years to come.
This funding is in addition to a substantial investment in resources to enhance the HSE’s medicines pricing and reimbursement process. This will deliver 34 new staff, and an online tracker which will allow patients and industry to follow the progress of an application through the assessment process. I am keen to provide this transparency for patients and I appreciate their important role in this process.
Building this capacity will support agencies to operate to the fullest of their ability, providing timely and efficient evaluation of medicines for reimbursement. This will provide greater certainty to industry and incentivise timely applications for reimbursement.
In making a relevant reimbursement decision, the HSE is required under the Act to have regard to nine criteria including efficacy, the health needs of the public, cost-effectiveness and potential or actual budget impact -
(1) The health needs of the public,
(2) The cost-effectiveness of meeting health needs by supplying the item concerned rather than providing other health services,
(3) The availability and suitability of items for supply or reimbursement,
(4) The proposed costs, benefits, and risks of the item or listed item relative to therapeutically similar items or listed items provided in other health service settings and the level of certainty in relation to the evidence of those costs, benefits and risks,
(5) The potential or actual budget impact of the item or listed item,
(6) The clinical need for the item or listed item,
(7) The appropriate level of clinical supervision required in relation to the item to ensure patient safety,
(8) The efficacy (performance in trial), effectiveness (performance in real situations) and added therapeutic benefit against existing standards of treatment (how much better it treats a condition than existing therapies) and
(9) The resources available to the HSE
HSE decisions on which medicines are reimbursed by the taxpayer are made on objective, scientific and economic grounds, on the advice of the National Centre for Pharmacoeconomics (NCPE). There are formal processes which govern applications for the pricing and reimbursement of medicines, and new uses of existing medicines, to be funded and/or reimbursed.
The NCPE has undertaken 756 Health Technology Assessments (HTAs) in the period 2019-2023, rising from 92 in 2019 to 238 in 2023.
The NCPE assess the information provided by health technology developers on the relative clinical effectiveness, cost effectiveness and budget impact of the new medicine compared to existing available treatments. In addition, the NCPE identify the key areas of uncertainty associated with these estimates. They do this in accordance with scientific rigour used in many other countries throughout Europe. It is recognised that there are limitations with the clinical evidence available to inform HTAs at the time of reimbursement application and this leads to a high level of uncertainty in the cost-effectiveness estimates.
The NCPE have taken a leading role in the development of cross-country guidelines for comparative clinical effectiveness which will be used across Europe under the new HTA Regulation, under which many medicines for rare diseases will be assessed from 2025 onwards. In particular, Ireland has worked closely with other countries, via the Beneluxa Initiative, in trying to identify and address the challenges that this has posed for healthcare systems.
1462. Deputy Steven Matthews asked the Minister for Health if his attention has been drawn to calls for the provision of local neurology services including access to a consultant neurologist in Wexford General Hospital; if this is under review within his Department; and if he will make a statement on the matter. [12784/24]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the deputy directly, as soon as possible.
1463. Deputy Catherine Murphy asked the Minister for Health the number of WTE vacant dental nurse positions currently in the Kildare primary care system; and the timeframe for which these vacancies will be filled, in tabular form. [12793/24]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly.
1464. Deputy Catherine Murphy asked the Minister for Health the estimated costs required for the purchase of additional helicopter for the HSE aeromedical services. [12794/24]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
1465. Deputy Catherine Murphy asked the Minister for Health the number of persons that were treated in the minor injuries unit in Smithfield in 2023 and to-date in 2024, in tabular form. [12795/24]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
1466. Deputy Catherine Murphy asked the Minister for Health the locations within public health service of obesity clinics; and the hours and days of the week each clinic is available, in tabular form. [12796/24]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
1467. Deputy Catherine Murphy asked the Minister for Health the locations within CHO9 where community specialist teams for older persons are based, in tabular form. [12797/24]
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 recently ended the industrial action which commenced on 6 October 2023. As a consequence, members in these grades were not engaging with political forums or processes. As a result of the accumulated backlog, the question asked by the Deputy may be delayed in receiving a response directly from the HSE.
1468. Deputy Catherine Murphy asked the Minister for Health the number of WTE consultants working within the clinical speciality of obesity and bariatric surgery across public health service. [12798/24]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
1469. Deputy Catherine Murphy asked the Minister for Health the number of WTE sonographers working in Naas General Hospital in 2022, 2023 and to-date in 2024, in tabular form. [12799/24]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
1470. Deputy Róisín Shortall asked the Minister for Health the number of people who died by suicide within 12 weeks of their discharge from a psychiatric hospital or unit, by hospital or unit, in 2021, 2022, 2023 and to date in 2024, in tabular form. [12803/24]
View answerAs this is a service matter, I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.
1471. Deputy Eoin Ó Broin asked the Minister for Health if a person (details supplied) can avail of treatment for a condition under the treatment abroad scheme or the cross border directive. [12805/24]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
1472. Deputy Maurice Quinlivan asked the Minister for Health the status of the case of a person (details supplied) who has been waiting for an appointment at the ophthalmology department at University Hospital Limerick and has yet to receive an appointment; and if he will make a statement on the matter. [12809/24]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible
1473. Deputy Éamon Ó Cuív asked the Minister for Health the new criteria used to assess applications for discretionary payments for items such as specialised spectacles for children in the CHO network; and if he will make a statement on the matter. [12816/24]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible
1474. Deputy Johnny Mythen asked the Minister for Health if a consultant neurologist post and services will be made available for Wexford General Hospital, in relation to commitments made to provide community care in the Programme for Government. [12819/24]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the deputy directly, as soon as possible.
1475. Deputy Eoin Ó Broin asked the Minister for Health if he is aware of the serious shortage of GP availability and GP appointment availability in the Dublin mid-west area; the steps that are being taken to increase GP provision in the area; and if he will make a statement on the matter. [12825/24]
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.
The Government is working to increase the number of GPs practicing in the State and thereby improve access to GP services across the country. Several measures have been taken to increase GP capacity, including increasing investment in general practice to support practices and make general practice a more attractive career choice, increasing the number of doctors training to become GPs, and establishing the non-EU GP Training Programme to rapidly bring more GPs to Ireland.
Under the 2019 GP Agreement additional annual expenditure provided for general practice was increased by €211.6m. This provided for significant increases in capitation fees for participating GMS GPs, and new fees for additional services and increased practice supports. The GP Agreement 2023 further increased GP capitation fees, increased the existing subsidy rates for practice staff, and introduced a grant support for additional staff capacity as well a practice staff maternity leave support.
These measures make general practice in Ireland a more attractive career choice for doctors. Figures released by the ICGP show that 1,311 medical graduates applied for GP training in 2024, a notable increase on the previous year and higher than any other year.
The number of doctors entering GP training has been increased significantly in recent years, with 286 new entrants in 2023 and 350 places planned for new entrants for this year. Annual intake to the GP training scheme has been increased by over 80% from 2015 to 2023, and the number of new entrant places to be available this year is a 22% increase on last year's intake.
Furthermore, GP recruitment is ongoing under the joint non-EU GP Training Programme between the HSE and Irish College of General Practitioners (ICGP). 112 non-EU GPs were recruited last year under the training programme and it is planned to recruit up to 250 more non-EU GPs to Ireland this year. The placement of GPs under the programme is targeted to rural and underserviced areas.
Lastly, my Department and the HSE have commenced a Strategic Review of General Practice. The review, with input from key stakeholders, is examining the broad range of issues affecting general practice including issues related to GP capacity. When completed, the review will set out the measures necessary to deliver a more sustainable general practice into the future.
1476. Deputy Richard Bruton asked the Minister for Health if he will consider removing mental health services from the present health recruitment embargo; and if a manpower plan for 2024 is close to agreement. [12850/24]
View answerAs this is an operational matter for the Health Service Executive, the HSE has been asked to respond directly to the Deputy.
1477. Deputy Jennifer Murnane O'Connor asked the Minister for Health the status of funding to support community-based service providers in the provision of health services across country for a service in County Carlow (details supplied). [12855/24]
View answerI wish to advise the Deputy that this is a matter for the Department of Children, Equality, Disability, Integration and Youth.
1478. Deputy Michael Lowry asked the Minister for Health if he will examine a matter concerning the lack of administrative support staff working in the oncology department of the HSE primary care centre on Mitchel Street, Thurles (details supplied); if he will provide an update on this issue; and if he will make a statement on the matter. [12856/24]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
1479. Deputy John Lahart asked the Minister for Health if consideration will be given to assessing medical card applications for individuals over 70 years-of-age based on their net income, in alignment with the current practice for those under 70 years-of-age, to ensure consistency across age groups; and if he will make a statement on the matter. [12870/24]
View answerEligibility for a Medical Card is primarily based on a financial assessment which is conducted by the HSE in accordance with the Health Act 1970 (as amended). The HSE assesses each medical card application on a qualifying financial threshold. This is the amount of money that an individual can earn a week and still qualify for a card. It is specific to the individual’s own financial circumstances.
Persons aged 69 and under are assessed under the general means tested medical card thresholds which are based on an applicant’s household income after tax and the deduction of PRSI and the Universal Social Charge. Certain expenses are also taken into account. Examples of allowable expenses include rent, mortgage, certain insurance costs, childcare, maintenance, nursing home net costs which help to increase the amount a person can earn and still qualify for a medical card. Detailed information is available at: www2.hse.ie/services/schemes-allowances/medical-cards/applying/assessment/.
Persons aged 70 or older are assessed under the over 70s medical card income thresholds which are based on gross income. In November 2020, the weekly gross medical card income thresholds for those aged 70 and over were increased to €550 per week for a single person and €1050 for a couple. This increase helps to ensure that a greater proportion of those aged 70 and over qualify for a medical card. However, it should be noted that those aged over 70 can also be assessed under the general means tested scheme where there are particularly high costs, e.g., medication, nursing home fees.
I can assure the Deputy that, to ensure the medical card system is responsive and sensitive to people's needs, my Department keeps medical card issues under review and any changes are considered in the context of Government policy and other issues which may be relevant.
1480. Deputy Fergus O'Dowd asked the Minister for Health if he will address a matter in relation to the new thresholds for GP cards and associated childcare costs (details supplied); and if he will make a statement on the matter. [12876/24]
View answerAs provided for under the GP Agreement 2023, means tested eligibility for a GP visit card was fully expanded to those who earn up to the median household income from 13 November 2023. It is important to note that means testing takes into consideration the number of dependents the applicant has as well as certain allowable expenses.
To provide for this expansion, the basic rates which are used in determining an individual's qualifying weekly financial threshold for eligibility for a GP visit card were increased to:
• Single person living alone aged up to 69: €418
• Single person living with family: €373
• Married or co-habiting couple with or without dependents: €607
• Lone parent: €607
An individual’s qualifying financial threshold is calculated by adding together three factors:
• the basic rate - an amount of money based on your age and household, as set out above;
• an amount allocated for each dependent; and
• an amount allocated for allowable expenses (for example, rent, mortgage payments, childcare costs, etc.).
The granting of eligibility through means testing is considered an objective, fair and equitable approach to granting eligibility to persons with lower incomes. To be eligible for a means-tested GP visit card the applicant’s weekly net income must be below their qualifying financial threshold. The qualifying threshold calculation takes into consideration the applicant’s particular expenses as well as their income, allowing for those who have a higher income but also experience high expenses to potentially qualify. This method helps to ensure that those with the least means to pay for GP services are eligible for GP care without charges.
1481. Deputy Michael Healy-Rae asked the Minister for Health when an appointment will be given to a person (details supplied); and if he will make a statement on the matter. [12885/24]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
1482. Deputy Cian O'Callaghan asked the Minister for Health if he intends to introduce subsidised or free FETAC Level 5 healthcare courses to ensure there are no barriers to entering the healthcare assistant profession; and if he will make a statement on the matter. [12888/24]
View answer1483. Deputy Bernard J. Durkan asked the Minister for Health when full payment under fair deal scheme as per the approval letter will be paid in the case of a person (details supplied); and if he will make a statement on the matter. [12893/24]
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 recently ended the industrial action which commenced on 6 October 2023. As a consequence, members in these grades were not engaging with political forums or processes. As a result of the accumulated backlog, the question asked by the Deputy may be delayed in receiving a response directly from the HSE.
1484. Deputy Colm Burke asked the Minister for Health if he will include the vaccine for chickenpox in the childhood immunisation programme; and if he will make a statement on the matter. [12894/24]
View answerThe immunisation programme in Ireland is based on the advice of the National Immunisation Advisory Committee (NIAC).
NIAC continue to revise its recommendations having regard to of the prevalence of the relevant disease in Ireland and international best practice in relation to immunisation. As the Deputy is aware, the varicella vaccine is not currently included as part of the primary childhood immunisation programme however NIAC has recommended that the vaccine is included in the programme.
My Department asked HIQA to carry out a Health Technology Assessment (HTA) on the Varicella Zoster Vaccine which was published on July 13th 2023.HIQA found that there is clear and consistent evidence that the chickenpox vaccine is both safe and effective in preventing chickenpox and its complications. It also found that adding the chickenpox vaccine to the programme is likely to be cost effective.
Having considered the findings of the HTA, I have approved the introduction of the varicella vaccine into the Primary Childhood Immunisation Programme, subject to funding being made available via the 2025 Estimates process.
