Written Answers Nos. 1216-1235
1216. Deputy Jerry Buttimer asked the Minister for Health his views on the increase of coeliac disease amongst the population; if there is any specific breakdown of the increase of coeliac disease in terms of age group or geographical location; and if he will make a statement on the matter. [16668/13]
Amharc ar fhreagra1217. Deputy Jerry Buttimer asked the Minister for Health if he or his officials' attention, or the Health Service Executive has been drawn to the UK National Institute for Health and Clinical Excellence Guidelines for the recognition and assessment of coeliac disease; if he will outline the national policy, if any, which currently exists for the recognition and assessment of coeliac disease here; and if he will make a statement on the matter. [16669/13]
Amharc ar fhreagra1218. Deputy Jerry Buttimer asked the Minister for Health the level of information, if any, that exists on the number of persons with undiagnosed coeliac disease who are misdiagnosed as having other conditions; the clinical and cost implications of same; and if he will make a statement on the matter. [16670/13]
Amharc ar fhreagra1219. Deputy Jerry Buttimer asked the Minister for Health his policy and the relevant agencies, on the most appropriate treatment for those with coeliac disease; the level of support for those on the general medical service scheme for access to this treatment; and if he will make a statement on the matter. [16671/13]
Amharc ar fhreagra1220. Deputy Jerry Buttimer asked the Minister for Health the commitment of his Department, and the relevant agencies, to encourage targeted screening for coeliac disease; the various elements which would be required to introduce such a screening programme; and if he will make a statement on the matter. [16672/13]
Amharc ar fhreagra1221. Deputy Jerry Buttimer asked the Minister for Health his policy and the Health Service Executive on what they deem to be a reasonable time from initial screening for coeliac disease to positivity; and if he will make a statement on the matter. [16673/13]
Amharc ar fhreagra1222. Deputy Jerry Buttimer asked the Minister for Health the commitment of the Health Service Executive to ensure access to dietetics for those newly diagnosed with coeliac disease; if he will seek details on the current take-up levels of the provision of this service through the HSE; and if he will make a statement on the matter. [16674/13]
Amharc ar fhreagraI propose to take Questions Nos. 1216 to 1222, inclusive, together.
Coeliac disease is a common digestive condition where a person is intolerant (has an adverse reaction) to the protein gluten which is found in wheat, barley and rye. If someone with coeliac disease is exposed to gluten, they may experience a wide range of symptoms and adverse effects, including diarrhoea, bloating, abdominal pain, weight loss and malnutrition. The cause or causes of coeliac disease are unknown, but it is thought to be associated with a combination of genetic and environmental factors.
Prevalence
During the 1980s, before advances in testing for coeliac disease were made, the condition was mistakenly thought to be rare.
Coeliac disease is now recognised to be a common condition that is thought to affect approximately 1 in every 100 people. Women are two to three times more likely to develop coeliac disease than men. Cases of coeliac disease have been diagnosed in people of all ages.
In some cases, coeliac disease does not cause any noticeable symptoms, or it causes very mild symptoms. As a result, it is thought that at least 50% or possibly as many as 90% of cases are either undiagnosed or misdiagnosed as other digestive conditions, such as irritable bowel syndrome (IBS). The Department of Health does not have information about the clinical and cost implications of undiagnosed cases. Data on the prevalence of coeliac disease in Ireland are not routinely available since it is not a condition covered either by statutory notification nor at present included in any disease registers.
Information on discharges from publicly-funded acute hospitals is collected via the Hospital Inpatient Enquiry (HIPE) system which records diagnoses and procedures for each in-patient and day case. Patients with a principal diagnosis of coeliac disease can be identified and the following Table displays the results for the period 2007 to 2011 by HSE region of residence and age group. The data shows an increase in discharges with this diagnosis over the period, particularly in the 0-14 age group. In the absence of prevalence data it is not possible to identify whether this increase indicates an increase in the disease or a change in diagnostic practice. It must be emphasised that the data refer only to hospitalised cases and that if a person is admitted more than once during the year for a specific condition each admission is counted separately in HIPE. For these reasons, the figures cannot be interpreted as an estimate of the prevalence of coeliac disease within the community.
Hospitalisations with a Principal Diagnosis of Coeliac Disease by HSE Region of Residence and Age, 2007 - 2011
|
HSE Region of Residence |
Age Group |
2007 |
2008 |
2009 |
2010 |
2011 |
|
0-14 Years |
29 |
39 |
39 |
41 |
67 |
|
|
15-44 Years |
74 |
101 |
83 |
70 |
74 |
|
|
Dublin Mid-Leinster |
45-64 Years |
77 |
73 |
71 |
69 |
49 |
|
65+ Years |
34 |
41 |
28 |
40 |
38 |
|
|
All Ages |
214 |
254 |
221 |
220 |
228 |
|
|
0-14 Years |
22 |
26 |
22 |
17 |
37 |
|
|
15-44 Years |
38 |
43 |
53 |
49 |
50 |
|
|
Dublin North-East |
45-64 Years |
36 |
39 |
39 |
48 |
39 |
|
65+ Years |
15 |
17 |
13 |
16 |
21 |
|
|
All Ages |
111 |
125 |
127 |
130 |
147 |
|
|
0-14 Years |
27 |
28 |
24 |
41 |
58 |
|
|
15-44 Years |
89 |
69 |
57 |
93 |
71 |
|
|
South |
45-64 Years |
89 |
57 |
63 |
76 |
64 |
|
65+ Years |
40 |
37 |
50 |
47 |
19 |
|
|
All Ages |
245 |
191 |
194 |
257 |
212 |
|
|
0-14 Years |
30 |
23 |
26 |
30 |
44 |
|
|
15-44 Years |
46 |
49 |
86 |
76 |
88 |
|
|
West |
45-64 Years |
52 |
64 |
58 |
72 |
72 |
|
65+ Years |
24 |
26 |
30 |
38 |
31 |
|
|
All Ages |
152 |
162 |
200 |
216 |
235 |
|
|
0-14 Years |
108 |
116 |
111 |
129 |
206 |
|
|
15-44 Years |
247 |
262 |
279 |
288 |
283 |
|
|
Total |
45-64 Years |
254 |
233 |
231 |
265 |
224 |
|
65+ Years |
113 |
121 |
121 |
141 |
109 |
|
|
All Ages |
722 |
732 |
742 |
823 |
822 |
Notes:
Source: Hospital In-patient Enquiry (HIPE).
The data reported above refer to inpatients and daycases with a principal diagnosis of Coeliac Disease (ICD-10-AM K90.0). Approximately 16% of the discharges reported above were re-admissions to the same hospital following a previous admission.
Treatment
Coeliac disease is usually treated by simply excluding foods that contain gluten from the diet. This prevents damage to the lining of the intestines (gut) that is caused by gluten, and the associated symptoms, such as diarrhoea and stomach pain. Many basic food items do not contain gluten and a wide range of gluten free alternatives to foods containing wheat, barley and rye is available in supermarkets and pharmacies.
Patients with coeliac disease can receive help and advice from their General Practitioner about dietary management and should also be referred for dietetic advice to ensure that the diet is balanced and contains all the nutrients needed, including essential vitamins and minerals.
In relation to the level of support available on the General Medical service for patients with coeliac disease, eligibility for health services in Ireland is based primarily on residency and means. The Health Act 1970 (as amended) provides for two categories of eligibility for all persons ordinarily resident in the country, i.e. full eligibility (medical card) and limited eligibility (all others). Full eligibility is determined mainly by reference to income limits and is granted to persons who, in the opinion of the Health Service Executive (HSE) are unable to provide general practitioner, medical and surgical services to persons and themselves and their dependants without undue hardship. There is a provision for discretion to grant a card in cases of "undue hardship" where the income guidelines are exceeded.
Persons with full eligibility (medical card holders) are entitled to a range of services including general practitioner services, prescribed drugs and medicines, all in-patient public hospital services in public wards including consultants services, all out-patient public hospital services including consultants services, dental, ophthalmic and aural services and appliances and maternity and infant care services. They are also entitled to prescribed drugs and medicines subject to a €1.50 charge per prescribed item (maximum charge of €19.50 per month). Other services such as allied health professional services may be available to medical card holders.
People with limited eligibility (non-medical card holders) are entitled, subject to certain charges, to all in-patient public hospital services in public wards including consultant services and out-patient pubic hospital services including consultants services. The current public hospital statutory in-patient charge is €75 per night, to a maximum of €750 in any twelve consecutive months. Attendance at accident and emergency departments is subject to a charge of €100 where the patient does not have a referral note from his/her doctor. This charge applies only to the first episode of care. Under the Drug Payment Schemes, no individual or family in this category pays more than €144 per calendar month towards the cost of approved prescribed medicines. The scheme significantly reduces the cost burden for families and individuals incurring ongoing expenditure on medicines.
In the current financial environment the Health Service Executive (HSE) faces a continuing challenge to deliver services in a way that will minimise any adverse impact on patients and continue to protect, as far as possible, the most vulnerable citizens. Unfortunately, as a result it has become necessary for the HSE to suspend certain products from its list of items reimbursable under the GMS and other community drug schemes. This includes gluten-free products.
Gluten-free products have become more widely available in supermarkets in recent years and tend to be significantly cheaper than products sold through community pharmacies. A Supplementary Welfare Allowance Adult Diet Supplement may be awarded by the Department of Social Protection to eligible persons. Persons wishing to apply for this allowance can do so by completing an application form which can be downloaded at the following link: http://www.welfare.ie/EN/Forms/Documents/swa9.pdf. Separate application forms are available for children. For persons who are not awarded a Diet Supplement, monies spent on gluten-free foods can be taken into account for tax purposes.
Screening
Screening for coeliac disease involves a two stage process:
blood tests to help identify people who may have coeliac disease
gut biopsy to confirm the diagnosis.
Routine screening for coeliac disease is not recommended unless a patient has symptoms associated with the condition or pre-existing risk factors.
In 2009, the UK National Institute for Health and Clinical Excellence (NICE) issued guidance about when testing for coeliac disease should be carried out. Information about the NICE guidance is available on the HSE website.
http://www.hse.ie/eng/services/flu/A-Z/C/Coeliac-disease/Diagnosing-coeliac-disease.html
The NICE guidance identifies the signs or symptoms for which testing for coeliac disease is strongly recommended for adults or children. The guidance also identifies a number of disease conditions in which testing for coeliac disease is or may be recommended.
In addition, I have arranged to have the Deputy's specific questions in relation to access to screening and access to dietetics referred to the HSE for attention and a more detailed response.
1223. Deputy Jerry Buttimer asked the Minister for Health the number of nurse prescribers employed by the Health Service Executive; the number of nurse prescribers appointed in each of the past two years; the amount of savings generated by nurse prescribers across the health system; and if he will make a statement on the matter. [16675/13]
Amharc ar fhreagraThe information regarding nurse prescribers is matter for the Health Service Executive (HSE). I have forwarded your queries to the HSE for direct response.
1226. Deputy Michael Healy-Rae asked the Minister for Health his views on special needs assistants hours (details supplied); and if he will make a statement on the matter. [16678/13]
Amharc ar fhreagraThe particular issue raised by the Deputy is a service matter for the Health Service Executive. Accordingly I have arranged for the question to be referred to the Health Service Executive for direct reply to the Deputy.
1227. Deputy Peter Mathews asked the Minister for Health if he will state the cost of the disposal of an unused bag of blood which has expired; and if he will make a statement on the matter. [16681/13]
Amharc ar fhreagraThe Irish Blood Transfusion Service (IBTS) remit is to provide a safe and reliable blood service to the Irish health system. Blood, and the products derived from it, are an integral facet of health care delivery. A major objective of the organisation is to ensure that it always has the necessary programmes and procedures in place to protect both the donors of blood and recipients of blood and blood products.
I have been informed by the IBTS that the cost of the disposal of an unused bag of blood is €0.95.
1228. Deputy Pearse Doherty asked the Minister for Health when a person (details supplied) may expect to receive treatment for a condition at Beaumont Hospital, Dublin. [16688/13]
Amharc ar fhreagraThe National Waiting List Management Policy, A standardised approach to managing scheduled care treatment for in-patient, day case and planned procedures, January 2013, has been developed to ensure that all administrative, managerial and clinical staff follow an agreed national minimum standard for the management and administration of waiting lists for scheduled care. This policy, which has recently been adopted by the HSE, sets out the processes that hospitals are to implement to manage waiting lists. In relation to this particular query raised by the Deputy, I have asked the Health Service Executive to investigate the situation and respond directly to the Deputy in this matter.
1229. Deputy Jerry Buttimer asked the Minister for Health his views on establishing an Institute for Forensic Toxicology in the State to reflect international best practice in the coronial service; and if he will make a statement on the matter. [16691/13]
Amharc ar fhreagraThe coronial service is the responsibility of the Department of Justice and Equality. However should it be decided to establish such an Institute my Department would be willing to co-operate fully in providing any support or expertise that would be required.
1230. Deputy Mattie McGrath asked the Minister for Health if, despite the fact that our national water supply has been artificially fluoridated for the past 49 years, there has been any testing of the chemicals for their safety on human health; if so, when this took place; if not, the reason for same; and if he will make a statement on the matter. [16692/13]
Amharc ar fhreagraThe Health (Fluoridation of Water Supplies) Act, 1960 provides for the fluoridation of public piped water supplies. The fluoride currently used is sourced as a primary product; it is mined directly from a raw material source, the mineral fluorospar as calcium fluoride (CaF2). It then goes through a purification process to conform to tightly controlled specifications under the requirements of CEN Standard I.S.EN 12175:2001 to produce hydrofluorosilicic acid, specifically used as the mineral additive, fluoride, to water. The consumer does not come into contact with the fluoridating agent. When added to water in the correct amount the acid dissolves and dissociates completely, releasing fluoride ions into the water.
1231. Deputy Michael Healy-Rae asked the Minister for Health the position regarding a medical card in respect of a person (details supplied) in County Kerry; and if he will make a statement on the matter. [16697/13]
Amharc ar fhreagraThe Health Service Executive has been asked to examine this matter and to reply to the Deputy as soon as possible.
The Health Service Executive operates the General Medical Services scheme, which includes medical cards and GP visit cards, under the Health Act 1970, as amended. It has established a dedicated contact service for members of the Oireachtas specifically for queries relating to medical cards and GP visit cards, which the Deputy may wish to use for an earlier response. Contact information has recently reissued to Oireachtas members.
1232. Deputy John O'Mahony asked the Minister for Health when a person (details supplied) in County Sligo will receive an appointment for an operation; the reason for the delay in receiving such an appointment; and if he will make a statement on the matter. [16702/13]
Amharc ar fhreagraImproving access to outpatient services is a key priority for the Government. Building on work already undertaken by the HSE, the National Treatment Purchase Fund has now taken over the reporting of outpatient waiting time data. For the first time data are available on www.ntpf.ie. The collation and analysis of outpatient waiting time data in a standardised format will reveal the distribution of long waiters across all hospitals. In the first instance, this will allow resources to be targeted towards those patients who are waiting longest and ensure that they are seen and assessed. For 2013, a maximum waiting time target has now been set of 12 months for a first time outpatient appointment.
In parallel with reducing the numbers of longest waiters, the SDU will also work with the HSE Clinical Programmes to reform the structure, organisation and delivery of outpatient services to ensure that the right patient is seen and assessed by the right health professional at the right time.
Should the patient's general practitioner consider that the patient's condition warrants an earlier appointment, he/she would be in the best position to take the matter up with the consultant and hospital involved.
In relation to the specific query raised by the Deputy, as this is a service matter it has been referred to the HSE for direct reply.
1233. Deputy Bernard J. Durkan asked the Minister for Health if and when a medical card will issue in the case of a person (details supplied) in County Kildare; and if he will make a statement on the matter. [16708/13]
Amharc ar fhreagraThe Health Service Executive has been asked to examine this matter and to reply to the Deputy as soon as possible.
The Health Service Executive operates the General Medical Services scheme, which includes medical cards and GP visit cards, under the Health Act 1970, as amended. It has established a dedicated contact service for members of the Oireachtas specifically for queries relating to medical cards and GP visit cards, which the Deputy may wish to use for an earlier response. Contact information has recently reissued to Oireachtas members.
1234. Deputy John O'Mahony asked the Minister for Health when funding will be approved for a primary care centre (details supplied) in County Mayo; and if he will make a statement on the matter. [16713/13]
Amharc ar fhreagraClaremorris is one of the 35 primary care centres locations announced under the infrastructure stimulus package in July 2012. Approximately 20 will be offered to the market subject to a) agreement between the local GPs and the HSE on active local GP involvement in the centres and b) site suitability and availability. The HSE is currently finalising matters relating to the available sites and GP engagement in each location. The HSE is also engaging with the National Development Finance Agency (NDFA) as required to progress Primary Care Centre Public Private Partnership. The NDFA as a centre of expertise will be responsible for the delivery of the Primary Care PPP programme on behalf of the HSE, including the management of the procurement phase and the provision of financial advice including a Value for Money assessment. It has been reviewing the processes involved in procurement of PPP projects with a view to streamlining the process and delivering projects more quickly. The preparatory work which precedes signing of any PPP agreement is well underway.
Public Private Partnership (PPP) involves a large element of up-front funding by the private sector and allows the cost of financing infrastructure to be spread over the lifetime of the asset. PPPs are reimbursed through annual unitary payments. As unitary payments are linked to performance over the lifetime of the project payments will only be made where the asset is delivered in line with the terms of the contract. While it is not possible, at this time, to give start and completion dates for any of the individual 20 potential locations, the best estimate is that these primary care centres will be completed by late 2016. Therefore it is estimated that the HSE is unlikely to make annual unitary payments before late 2016.
1235. Deputy Clare Daly asked the Minister for Health if he will address the issue of infertility treatment in Ireland from the point of view of the lack of available clinics for medical card holders and the inadequate private health insurance cover for many of the treatments, with particular reference to considering a model as operated under the NHS, where couples get a minimum of one free treatment and can apply for up to three treatments, or that greater provision is delivered through health insurance reform. [16714/13]
Amharc ar fhreagraAssisted Human Reproduction treatment (AHR) is not provided or funded by the public health system; such treatment is available from clinics that operate privately. Patients who access these services privately may claim tax relief on the costs involved under the tax relief for medical expenses scheme.
In addition, a defined list of fertility medicines needed for fertility treatment is covered under the High Tech Scheme administered by the Health Service Executive. Medicines covered by the High Tech Scheme must be prescribed by a consultant/specialist and authorised by the High Tech Liaison Officers. The cost of the medicines is reflected in the PCRS Statistical Analysis of Claims and Payments under High Tech Drugs. Patients may then use their valid established eligibility for GMS or Drug Payment Scheme, as appropriate, to access the medicines.
I am conscious of the financial burden that fertility services can place on the couples concerned; however, this matter has to be considered in the context of the difficult economic situation that prevails and the other compelling funding demands across a full range of health issues.
