Brendan Ryan
Ceist:1134. Deputy Brendan Ryan asked the Minister for Health the position on the proposed self-assessment review forms for medical card holders. [35374/13]
Amharc ar fhreagraMedical Card Eligibility
Ceisteanna (1134, 1135)
Brendan Ryan
Ceist:1135. Deputy Brendan Ryan asked the Minister for Health when the proposed self-assessment review forms will be issued to medical card holders as standard practice; and if he will make a statement on the matter. [35375/13]
Amharc ar fhreagraFreagraí scríofa
I propose to take Questions Nos. 1134 and 1135 together.
Self-assessment forms are currently issued by the HSE, Primary Care Reimbursement Service (PCRS) to Medical Card/G.P. Visit Card holders for both the 0-69 and over 70s age groups.
Generic Drugs Substitution
Ceisteanna (1136)
Kevin Humphreys
Ceist:1136. Deputy Kevin Humphreys asked the Minister for Health the amount that has been saved by using generic drugs in 2013; his plans to ensure further savings are made; and if he will make a statement on the matter. [35398/13]
Amharc ar fhreagraFreagraí scríofa
Following intensive negotiations involving the Irish Pharmaceutical Healthcare Association (IPHA), the HSE and the Department of Health, a major new deal on the cost of drugs in the State was concluded in October last. It will deliver a number of important benefits, including
- significant reductions for patients in the cost of drugs,
- a lowering of the drugs bill to the State,
- timely access for patients to new cutting-edge drugs for certain conditions, and
- reducing the cost base of the health system into the future.
The IPHA agreement provides that prices are referenced to the currency adjusted average price to wholesaler in the nominated EU member states in which the medicine is then available. The prices of a range of medicines were reduced on 1 November and further price reductions were implemented on 1 January 2013 in accordance with the agreement.
The gross savings arising from this deal will be in excess of €400 million over 3 years. Some €210 million from the gross savings will make available new drugs to patients over 3 years. Thus, the deal will result in a net reduction in the HSE expenditure on drugs of about €190 million.
The Department of Health and the HSE also successfully finalised discussions with the Association of Pharmaceutical Manufacturers in Ireland (APMI), which represents the generic industry, on a new agreement to deliver further savings in the cost of generic drugs. Under this Agreement, since 1 November 2012, the HSE only reimburses generic products which have been priced at 50% or less of the initial price of an originator medicine. In the event that an originator medicine is priced at less than 50% of its initial price the HSE requires a generic medicine to be priced below the originator price. This represents a significant structural change in generic drug pricing and should lead to an increase in the generic prescribing rate.
It is estimated that the combined gross savings from the IPHA and APMI deals will be in excess of €120 million in 2013. The Health (Pricing and Supply of Medical Goods) Act 2013, which came into operation on 24 June, will introduce a system of generic substitution and reference pricing. Under the Act, the Irish Medicines Board (IMB) is responsible for the assessment for interchangeability of medicines. The IMB will review an initial 20 active substances, which equates to approximately 1,500 individual medicines. They include statins, proton pump inhibitors, angiotensin-converting-enzyme (ACE) inhibitors and angiotensin II receptor blockers.
It is expected that the first List of Interchangeable Medicines, containing groups of atorvastatin products, will be published in mid-August at which time generic prices will fall by 20%. The IMB will publish subsequent lists for other groups of medicines on an ongoing basis.
The Act also provides that the HSE may set a reference price for each group of interchangeable products published on the List of Interchangeable Products. Reference pricing involves the setting of a common reimbursement price, or reference price, for a group of interchangeable medicines. It means that one reference price is set for each group or list of interchangeable medicines and this is the price that the HSE will reimburse to pharmacies for all medicines in the group, regardless of the individual medicine’s prices. The first reference price is expected to be implemented by November.
Graduate Nursing Scheme Application Numbers
Ceisteanna (1137)
Kevin Humphreys
Ceist:1137. Deputy Kevin Humphreys asked the Minister for Health the number of positions that have been filled under the nursing and midwifery graduate initiative to date in 2013; the way this level of recruitment affects the projected savings from the scheme; his plans to offer nurses on the scheme permanent places after the end of the two year placement to encourage recruitment; and if he will make a statement on the matter. [35399/13]
Amharc ar fhreagraFreagraí scríofa
A major objective of this scheme was to put in place more cost-effective service delivery arrangements, having regard to the high rates of expenditure on agency staffing and overtime. The scheme will enable the health services to offer 1,000 graduate nurses positions for two years. It will support the retention of recently qualified graduate nurses and midwives within the Irish health system and enable them to gain valuable work experience and development opportunities post-graduation, at a time when job opportunities in the public service are very limited.
The nursing unions were strongly opposed to the scheme and, as a result, the number of staff appointed to date has been limited. At this stage 18 applicants have been assigned to work locations and have taken up their posts. A further 48 applicants have accepted offers but have yet to take up duty. Under the Haddington Road Agreement it has been agreed that higher salary rates will be payable to participants in this scheme and in this context the relevant unions have withdrawn their opposition to its implementation.
The HSE will shortly be proceeding to invite further applications and to facilitate qualified applicants with offers of appointment to posts in the part of the country for which they have expressed a preference. Recruitment will continue during 2013, with a particular focus on nurses who will be graduating next autumn. A savings target of €10 million was factored into the HSE's budget for 2013. It is too early at this point to assess whether this level of saving will be achieved.
The Minister for Public Expenditure and Reform approved the Graduate Nurse Placement Initiative on the basis that participants would not be counted in health service staff numbers and that it would contribute to savings on unsustainable levels of agency and overtime expenditure. Appointments under the scheme will, accordingly, be made strictly for a two year period. It will be open to participants to compete in the normal way for appointment to a permanent post in the health service, in the event of recruitment to such positions taking place.
Home Help Service Provision
Ceisteanna (1138)
Michael McCarthy
Ceist:1138. Deputy Michael McCarthy asked the Minister for Health the number of home help hours currently being delivered in Cork South West; if he will undertake a review of hours in areas (details supplied); and if he will make a statement on the matter. [35404/13]
Amharc ar fhreagraFreagraí scríofa
As this is a service matter it has been referred to the Health Service Executive for direct reply.
Vaccination Programme
Ceisteanna (1139)
Billy Kelleher
Ceist:1139. Deputy Billy Kelleher asked the Minister for Health the supports he plans to put in place for persons suffering from narcolepsy and other medical complications following vaccination with Pandemrix; if he has met the support group, SOUND, or has plans to meet it; and if he will make a statement on the matter. [35436/13]
Amharc ar fhreagraFreagraí scríofa
I am pleased to inform the Deputy that there are a number of supports in place for persons diagnosed with narcolepsy following pandemic vaccination. My priority is to ensure that those affected by narcolepsy, with symptom onset post pandemic vaccination are provided with a range of services and supports to meet their health needs. Both officials from my Department, the Health Service Executive and the Department of Education and Skills and I have met with the relevant advocacy group on a number of occasions to address their concerns and to outline the services available.
The Health Service Executive has responsibility for health service delivery and at my request, the HSE developed a range of appropriate services and supports to address the needs of this group. Together, the HSE and the Department of Education and Skills provide a very comprehensive range of services and supports to those affected.
These supports and services include access to rapid diagnosis, clear treatment pathways, temporary medical cards and reimbursement of expenses incurred. This includes expenses for counselling services for individuals and also for families of children affected by narcolepsy following pandemic vaccination, in cases where such services are not already available through the HSE. Multi-disciplinary assessments which allow for appropriate individualised health and educational supports to be put in place are ongoing. The National Educational Psychological Service (NEPS) is also engaging with the HSE and with the individual schools and parents of children concerned to identify and provide educational supports for the children and adolescents affected.
The HSE's advocacy unit is in regular contact with the support group SOUND and last met representatives of the group on 17 May 2013. Through regional co-ordinators the HSE also has frequent contact with individual members of SOUND to assist them in service access and reimbursement of expenses. The HSE recently held an information day for staff, also attended by SOUND, to ensure awareness of all the relevant services available. My Department is considering all possible supports which may need to be put in place for those affected by narcolepsy following pandemic vaccination. I would like to assure the Deputy that this matter continues to be a priority for my Department.
Health Services Issues
Ceisteanna (1140)
Jack Wall
Ceist:1140. Deputy Jack Wall asked the Minister for Health the reason a child (details supplied) in County Kildare has been informed that their support services will cease in August this year; and if he will make a statement on the matter. [35445/13]
Amharc ar fhreagraFreagraí scríofa
The 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.
Question No. 1141 answered with Question No. 1037.
Mental Health Services Provision
Ceisteanna (1142)
Denis Naughten
Ceist:1142. Deputy Denis Naughten asked the Minister for Health if he will report on the meeting with Roscommon-Galway primary, community and continuing care services on 4 July regarding mental health services in the area and the provision of an psychiatric intensive care rehabilitation unit; and if he will make a statement on the matter. [35464/13]
Amharc ar fhreagraFreagraí scríofa
The Deputy will appreciate that the Health Service Executive has statutory responsibility for the planning and delivery of services at local level. This includes management of this particular facility as part of a single mental health service across Galway and Roscommon, which also encompasses similar acute units at Ballinasloe and Galway. In circumstances where one of these units reaches maximum operational capacity, for whatever reason, then incoming patients receive treatment in one of the other units. This is normal practice in acute mental health provision nationally.
It should be emphasised that addressing relevant issues at this facility can only be viewed in the context of wider changes in the health service, including in the mental health area, and the need to provide in the future the most appropriate and best possible service at this Unit, in line with agreed mental health policy and service norms applicable elsewhere. This process is currently being undertaken by the HSE and will obviously have to take account of all relevant options, including the type of unit proposed in the Deputy's question.
I have been closely monitoring developments on the issue raised and I met with officials from the Executive on 10 July last to review the evolving situation. The Deputy can rest assured that I will continue to liaise with the Executive, with a view to ensuring the best outcomes for the future of the mental health services across Galway and Roscommon.
General Medical Services Scheme Administration
Ceisteanna (1143)
Denis Naughten
Ceist:1143. Deputy Denis Naughten asked the Minister for Health if he will include new medical stoma appliances in the list of reimbursable items under the GMS scheme; when the list of reimbursable items was last revised to include a new stoma product; if his attention has been drawn to the hardship both medical and financial caused to persons by delays in approving such products; and if he will make a statement on the matter. [35465/13]
Amharc ar fhreagraFreagraí scríofa
A range of stoma products is on the List of Reimbursable Items under the GMS Scheme. Furthermore, where a product that is not on the list is required, application can be made by a medical card holder for the product to be made available through discretionary hardship arrangements.
The HSE is reviewing on a sequential basis, all non drug items on the list. Clinical nutritional products have been completed, significant work on dressings has been conducted and the HSE hopes to proceed to the Ostomy-Colostomy area later this year, as resources allow.
Services for People with Disabilities
Ceisteanna (1144)
Finian McGrath
Ceist:1144. Deputy Finian McGrath asked the Minister for Health the position on qualification for disability benefit in respect of a person (details supplied) in Dublin 3. [35501/13]
Amharc ar fhreagraFreagraí scríofa
The HSE has been asked to examine the specific query raised by the Deputy and to reply to him as soon as possible.
Medical Card Eligibility
Ceisteanna (1145)
Michael Healy-Rae
Ceist:1145. Deputy Michael Healy-Rae asked the Minister for Health if he will disclose further details of his recent statements on the granting of medical cards to non-terminal cancer patients, whereby he stated that they were no longer guaranteed a medical card; and if he will make a statement on the matter. [35505/13]
Amharc ar fhreagraFreagraí scríofa
In accordance with the 1970 Health Act, the assessment for a medical card is determined primarily by reference to the overall financial situation of the applicant and his or her partner and dependants. In line with the legislation, there is no automatic entitlement to a medical card for persons with cancer, or any other specific illness. There has been no change in entitlement in this regard.
The processing of medical cards at a national level ensures that all people are treated in a similar, fair manner. While people with specific illnesses such as cancer are not automatically entitled to medical cards, the legislation provides for discretion by the HSE to grant a medical card where a person's income exceeds the income guidelines. The HSE takes a person's social and medical issues into account when determining whether there is "undue hardship" for a person in providing a health service for himself or herself or his or her dependants.
At the request of the Minister for Health, the HSE set up a clinical panel to assist in the processing of applications for such discretionary medical cards, where there are difficult personal circumstances. This procedure ensures that the specific situation of a person with a particular diagnosis, such as one of the many forms of cancer, can be considered on a case-by-case basis.
The HSE also has a separate procedure in place for the provision of emergency medical cards for patients who are seriously ill and in urgent need of medical care that they cannot afford. Emergency medical cards are issued by the HSE within twenty-four hours of receipt of the required patient details and the letter of confirmation of the condition from a doctor or a medical consultant. With the exception of terminally ill patients, the HSE issues all emergency cards on the basis that the patient is eligible for a medical card on the basis of means or undue hardship, and that the applicant will follow up with a full application within a number of weeks of receiving the emergency card. As a result, emergency medical cards are issued to a named individual, with a limited eligibility period of six months.
The arrangement differs for persons with a terminal illness. Once the terminal illness is verified, patients are given an emergency medical card for six months. Given the nature and urgency of the issue, the HSE has appropriate escalation routes to ensure that the person gets the card as quickly as possible.
The HSE ensures that the system responds to the variety of circumstances and complexities faced by individuals in these circumstances.
Medical Card Applications
Ceisteanna (1146)
Michael Healy-Rae
Ceist:1146. Deputy Michael Healy-Rae asked the Minister for Health the position on a medical card in respect of a person (details supplied) in County Kerry; and if he will make a statement on the matter. [35512/13]
Amharc ar fhreagraFreagraí scríofa
The 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 issued to Oireachtas Members.
Question No. 1147 answered with Question No. 1077.
Home Help Service Provision
Ceisteanna (1148)
Róisín Shortall
Ceist:1148. Deputy Róisín Shortall asked the Minister for Health the number of home help hours allocated to Health Service Executive Areas 6 and 7; the corresponding allocation for home care packages; and if he will make a statement on the matter. [35520/13]
Amharc ar fhreagraFreagraí scríofa
As this is a service matter it has been referred to the Health Service Executive for direct reply.
Question No. 1149 answered with Question No. 1037.
Medical Card Eligibility
Ceisteanna (1150)
Patrick Nulty
Ceist:1150. Deputy Patrick Nulty asked the Minister for Health if he will review as a matter of urgency recent changes to the rules for medical card eligibility, namely, the exclusion of home improvement loan payments and travel-to-work expenses; if his attention has been drawn to the difficulties this is causing persons in serious need of a medical card; and if he will make a statement on the matter. [35528/13]
Amharc ar fhreagraFreagraí scríofa
Changes were made earlier this year to the medical card means test and to the income thresholds for over 70s medical cards. These changes were made on foot of Budget 2013 which identified a wide range of savings that were required across the health services. The General Medical Service (GMS) Scheme was one of a number of areas identified in which savings were required.
A number of measures are being taken to reduce the cost of the GMS, which costs about €2 billion per year. At the end of 2012, there were about 1,986,000 qualifying people under the GMS. Medical cards make up the majority of this number, amounting to about 93% of the total. As part of Budget 2013, the Government has made provision for an additional 200,000 persons to be covered by the GMS. Nonetheless, it is important that we prioritise the use of scarce financial resources in the current budgetary position.
Among the Budget 2013 savings measures announced was a reduction in the income limits for over-70s Medical Cards. It should be noted that the overwhelming majority of medical cardholders aged over 70 years are unaffected by that change. For the wealthiest 5 per cent that are affected, those cardholders under the old income limits will continue to be provided with a free GP service. The Health (Alteration of Criteria for Eligibility) Act 2013 was enacted on 28 March 2013 to give effect to the revised eligibility arrangements.
At that time also, it was also announced that the rules on a person's expenses that are taken into account in calculating their net income for medical card purposes would be tightened. The changes introduced by the Health Service Executive mean that payments on a home improvement loan and a €50 per week allowance for a car are excluded from the standard means test assessment. These changes took effect from April onwards.
For clarity, the exclusion from travel to work costs relates to removing the weekly amount of €50 allowed to cover standing charges, such as depreciation or other running costs, used when considering travel to work costs as an outgoing where public transport is not available or suitable and a car is required. This means that the HSE will continue to consider the standard mileage costs or public transport costs when assessing eligibility.
There are a broad range of allowable expenses under the means test assessment for medical cards that have not been affected by these changes and the need to reduce the income limits for medical cards has been avoided, by these measures.