Tuesday, 5 Nov 2013

Written Answers Nos. 1052 - 1072

Medical Aids and Appliances Provision

Ceisteanna (1052)

Robert Troy

Ceist:

1052. Deputy Robert Troy asked the Minister for Health if he will ensure that a person (details supplied) is granted a swivel chair for their vehicle as they suffer mobility problems. [45832/13]

Freagraí scríofa

Minister of State at the Department of Health

As the Deputy's question relates to service matters I have arranged for the question to be referred to the Health Service Executive for direct reply to the Deputy.

Medical Card Applications

Ceisteanna (1053)

Bernard Durkan

Ceist:

1053. Deputy Bernard J. Durkan asked the Minister for Health if and when a medical card will issue to a person (details supplied) in County Kildare; and if he will make a statement on the matter. [45842/13]

Freagraí scríofa

Minister of State at the Department of Health (Deputy Alex White)

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.

Health Services Provision

Ceisteanna (1054)

Seán Kenny

Ceist:

1054. Deputy Seán Kenny asked the Minister for Health his plans to improve the D-Doc services; and if he will make a statement on the matter. [45862/13]

Freagraí scríofa

Minister of State at the Department of Health (Deputy Alex White)

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

Nursing Staff Provision

Ceisteanna (1055)

Seán Kenny

Ceist:

1055. Deputy Seán Kenny asked the Minister for Health the number of spina bifida nurse specialists working in the public health services in 2010, 2011, 2012 and to date in 2013; the hospitals where they are located; and if he will make a statement on the matter. [45863/13]

Freagraí scríofa

Minister for Health

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

Medical Card Eligibility

Ceisteanna (1056)

Terence Flanagan

Ceist:

1056. Deputy Terence Flanagan asked the Minister for Health if terminally ill children will be supplied with medical cards before the Government delivers medical cards to all children under five years of age; and if he will make a statement on the matter. [45874/13]

Freagraí scríofa

Minister of State at the Department of Health (Deputy Alex White)

The HSE has an effective system in place for the provision of emergency medical cards for patients who are terminally ill, or who are seriously ill and in urgent need of medical care that they cannot afford. They are issued 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 grounds 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. For persons with a terminal illness, no means test applies. 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. If a baby is in palliative care, an emergency medical card may be issued by the HSE. Neither a birth certificate not a personal public service number for the baby is required in such instances in order to apply for a medical card.

The Government is committed to introducing, on a phased basis, a universal GP service without fees within its term of office, as set out in the Programme for Government and the Future Health strategy framework. As announced in the Budget, it has been decided to commence the roll-out of a universal GP service by providing all children aged 5 and under with access to a GP service without fees. This will mean that almost half of the population will have access to GP services without fees. The Government is providing new, additional funding of €37 million to meet the cost of this measure. The implementation of this measure will require primary legislation. The necessary administrative arrangements will be made during the course of 2014 when the specifics of the legislation are known.

Long-Term Illness Scheme Coverage

Ceisteanna (1057, 1066, 1172, 1183, 1184)

Tom Fleming

Ceist:

1057. Deputy Tom Fleming asked the Minister for Health if he will issue a long term illness card as a matter of urgency in respect of a person (details supplied) in County Kerry; and if he will make a statement on the matter. [45878/13]

Clare Daly

Ceist:

1066. Deputy Clare Daly asked the Minister for Health his plans to amend the Health Act 1970, in order to include colitis and Crohn's disease as a long-term illness which should be covered by the disability scheme [45914/13]

Joanna Tuffy

Ceist:

1172. Deputy Joanna Tuffy asked the Minister for Health if he will provide an update on plans to make provision in terms of entitlements to persons with long-term illnesses; and if he will make a statement on the matter. [46625/13]

Terence Flanagan

Ceist:

1183. Deputy Terence Flanagan asked the Minister for Health if a person (details supplied) in Dublin 5 is covered under the long-term illness scheme; and if he will make a statement on the matter. [46732/13]

Terence Flanagan

Ceist:

1184. Deputy Terence Flanagan asked the Minister for Health if a person (details supplied) in Dublin 3 is covered under the long-term illness scheme; and if he will make a statement on the matter. [46733/13]

Freagraí scríofa

Minister of State at the Department of Health (Deputy Alex White)

I propose to take Questions Nos. 1057, 1066, 1172, 1183 and 1184 together.

There are no plans to extend the list of conditions covered by the long-term illness scheme. Under the drug payment scheme, no individual or family 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 addition, people who cannot, without undue hardship, arrange for the provision of medical services for themselves and their dependants may be entitled to a medical card. In the assessment process, the Health Service Executive can take into account medical costs incurred by an individual or a family. Those who are not eligible for a medical card may still be able to avail of a GP visit card, which covers the cost of general practice consultation. In relation to the individual cases cited, the HSE is responsible for the administration of the long-term illness scheme, therefore, these matters have been referred to the HSE for attention and direct reply to the Deputies.

Medical Card Eligibility

Ceisteanna (1058)

Caoimhghín Ó Caoláin

Ceist:

1058. Deputy Caoimhghín Ó Caoláin asked the Minister for Health if the HSE is differentiating between cancer patients with and without terminal cancer in the assessment of eligibility for discretionary medical cards; and if he will make a statement on the matter. [45881/13]

Freagraí scríofa

Minister of State at the Department of Health (Deputy Alex White)

The HSE has a system in place for the provision of discretionary emergency medical cards for patients who are seriously ill and in urgent need of medical care that they cannot afford. These are issued within 24 hours of receipt of the required patient details and a letter which confirms the medical condition from a doctor or consultant. With the exception of terminally ill patients in palliative care, all emergency cards are issued on the basis that the patient is eligible for a medical card on the basis of means or undue hardship, and will follow up with a full application within a number of weeks of receiving the emergency card.

The arrangement is slightly different for persons with a terminal illness in palliative care. The nature of the terminal illness is not a deciding factor in the issue of an emergency medical card in these circumstances and no means test applies. Emergency medical cards are issued to a named individual, with a limited eligibility period of six months.

Primary Care Reimbursement Service Payments

Ceisteanna (1059)

Caoimhghín Ó Caoláin

Ceist:

1059. Deputy Caoimhghín Ó Caoláin asked the Minister for Health the progress that has been made with the programme for Government commitment to establish a primary care fund to pay providers of primary care [45882/13]

Freagraí scríofa

Minister of State at the Department of Health (Deputy Alex White)

The HSE’s National Service Plan for 2013 sets out the funding allocations for this year by care group programme. It includes provision of €2,562 million in respect of the Primary Care Reimbursement Service and €400 million for Primary Care services. This is an increase of 1.7% and 7.6% respectively on the 2012 figures. Successful transformation of our health services requires a corresponding transformation of our funding model. The first stage in transforming our funding model is to clarify funding streams through the creation of directorates and corresponding programme based budgets. As part of this process, a Primary Care Directorate was established within the HSE. This directorate will oversee the development and strengthening of primary care.

Based on the recommendations of the reviews of financial management systems in the health service, the HSE established a Finance Reform Programme in November 2012. Central to the establishment of this programme was the recognition that successful implementation of the Government’s Future Health reform agenda will require a fundamental change in the way financial management is delivered across the health system in Ireland. The Finance Reform Programme is overseen by the Finance Reform Board, chaired by the Director General of the Health Service and has representation from the HSE Senior Leadership Team, the Department of Health and the Department of Public Expenditure and Reform.

The most recent meeting of the Finance Reform Board was held on 9 September 2013 and endorsed the output from Phase 1 of the Finance Reform Programme. The process for planning for Phase 2 of the Finance Reform Programme is currently underway which will include finalising the business case for the implementation of a unified financial system for the health services. It is clear that the new requirements from Future Health cannot be delivered within the current arrangements, and that a new operating model for finance is essential to build the foundations for System Reform.

Medical Card Eligibility

Ceisteanna (1060, 1092)

Catherine Murphy

Ceist:

1060. Deputy Catherine Murphy asked the Minister for Health the weighting policy that is applied to the circumstances of applications for discretionary medical cards; and if he will make a statement on the matter. [45884/13]

Olivia Mitchell

Ceist:

1092. Deputy Olivia Mitchell asked the Minister for Health the circumstances and their relative weighting, other than income, which are taken into consideration in awarding a medical card; and if he will make a statement on the matter. [46104/13]

Freagraí scríofa

Minister of State at the Department of Health (Deputy Alex White)

I propose to take Questions Nos. 1060 and 1092 together.

The 1970 Health Act states that persons who are unable, without undue hardship, to arrange GP services for themselves and family qualify for a medical card, having regard to the overall financial situation of the applicant and his/her dependants. Applications are, in the first instance, subject to a means assessment to determine if assessable income declared is within the set income limits to qualify for a medical card or a GP visit card. Medical card and GP visit card applications are considered in accordance with the Medical Card and GP Visit Card National Assessment Guidelines.

If an application is assessed over the qualifying financial thresholds for both a medical card and GP visit card or assessed as under the qualifying thresholds for a GP visit card only, and the application also includes other medical, social or financial details that do not form part of the means assessment, the application will then be considered on discretionary grounds for a grant of a card under the provisions relating to "undue hardship"-"unduly burdensome" to arrange GP services for the medical card scheme of assessment. The assessment to be made in this instance is whether it is considered that "undue hardship" will occur or an "undue burden" be placed on the applicant(s) in providing for his/her medical needs or his/her family dependants’ medical needs in the absence of medical card or GP visit card eligibility.

The National Assessment Guidelines provide guidance to a decision maker as to the relevant factors to have regard to in making an assessment as to whether the ‘undue hardship’/’undue burden’ provisions apply to the circumstances presented on an application. In particular, the guidelines state that the ‘exercise of discretion by the HSE, in favour of the applicant, should be considered where meeting the costs of services covered by a Medical Card or a GP Visit Card compromises the applicant’s or his/her family’s ability to meet the essential costs associated with:

- maintenance of employment

- provision of reasonable housing

- provision of appropriate nurturing and care for children or dependants

- provision of adequate heating, nutrition and clothing, or

- coping with exceptional personal and financial burdens arising from medical or social circumstances.

In conducting this assessment, the Guidelines state that the following issues be taken account of on an application:

- Illness or medical circumstances which results in financial hardship.

- The cost of providing general medical and surgical services.

- The cost associated with the provision of medical, nursing and dental treatment.

- The cost of physiotherapy and speech and language therapy.

- Transport cost to hospitals and clinics.

- Addictions such as drink, drugs and gambling.

- Poor money management.

- Social deprivation – including poor home management.

- The cost of medical aids and appliances.

The HSE will give equal consideration to each of the above factors that present on an application in deciding whether to approve that application for grant of a medical card on grounds of ‘undue hardship’/’undue burden’.

The decision maker may make appropriate inquires or seek advice from other sources to assist with coming to a decision on ‘undue hardship’/’undue burden’; these sources may include:

- The Applicant’s Doctor(s).

- The HSE’s Medical Officers.

- The Public Health Nurse.

- The Community Welfare Officer.

- Social Worker.

- Therapy Services.

- Money Advice and Budgeting Service (MABS).

I trust the above clarifies the circumstances, in addition to income, taken into account in deciding whether to approve medical card eligibility on discretionary grounds.

Health Services Provision

Ceisteanna (1061)

James Bannon

Ceist:

1061. Deputy James Bannon asked the Minister for Health if a person (details supplied) in County Longford will be allowed any benefit towards the cost of a neurological appointment in Dublin; and if he will make a statement on the matter. [45894/13]

Freagraí scríofa

Minister of State at the Department of Health (Deputy Alex White)

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.

Health Services Provision

Ceisteanna (1062)

James Bannon

Ceist:

1062. Deputy James Bannon asked the Minister for Health if a person (details supplied) in County Longford will be allowed any benefit towards the cost of a neurological appointment in Dublin; and if he will make a statement on the matter. [45895/13]

Freagraí scríofa

Minister of State at the Department of Health (Deputy Alex White)

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.

Health Services Staff Issues

Ceisteanna (1063)

Eoghan Murphy

Ceist:

1063. Deputy Eoghan Murphy asked the Minister for Health his views on the following proposal in relation to junior doctors (details supplied); and if he will make a statement on the matter. [45901/13]

Freagraí scríofa

Minister for Health

There is a need to address the significant challenges that currently exist in relation to the recruitment and retention of young doctors in Ireland. In this context, in July of this year I established a Working Group, chaired by Professor Brian MacCraith, President of DCU, to carry out a Strategic Review of Medical Training and Career Structure. The Working Group will examine and make high-level recommendations relating to training and career pathways for doctors with a view to improving graduate retention in the public health system, planning for future service needs and realising maximum benefit from investment in medical education and training.

In the course of its work, the Group will examine a range of issues including the pathway for training at every level from Intern to Specialist, and the potential for reducing the length of specialist training. It will also consider mentoring and career planning supports for medical graduates, as well as measures to improve the quality of the training experience.

In examining these issues, the Working Group will take account of:

- the need to ensure quality, safe, patient-centred health care;

- developments in the clinical programmes and recent reports and recommendations relevant to patient safety;

- opportunities arising from the Health Reform Programme (for example, the development of hospital groups and the expansion of primary care services);

- the achievement of value for money for the State's investment in medical education and training;

- international good practice in regard to medical training and developments, including EU requirements.

I have requested an initial report from the Working Group by the end of November 2013 and a final report by the end of June 2014.

Palliative Care for Children

Ceisteanna (1064)

Denis Naughten

Ceist:

1064. Deputy Denis Naughten asked the Minister for Health the total spend in the past 12 month period in each primary community and continuing care area on home nursing care for children with life-limiting conditions; the number of children who availed of the service in each area; and if he will make a statement on the matter. [45905/13]

Freagraí scríofa

Minister of State at the Department of Health

The issue of the provision of home care packages for children with life-limiting conditions is complex. This group includes children who may require short to medium care, children who have a disability and require long-term care and also sick children for whom there is no reasonable hope of a cure and who are expected to die. "Palliative Care for Children with Life-limiting Conditions in Ireland - a National Policy" (2010), provides the foundation and sets out clear direction for the development of an integrated palliative care service for children and their families, across all care settings.

Following the publication of the policy document, the National Development Committee for Children's Palliative Care (NDC) was established by the Health Service Executive (HSE). The Committee is chaired by the HSE and has overall responsibility for overseeing the implementation of the national policy. The Committee's membership includes statutory, voluntary, professional and parent representatives. The Irish Hospice Foundation (IHF), LauraLynn's Children's Hospice and the Jack & Jill Foundation are members.

In 2012, HSE regions spent approximately €8.58 million on home nursing for children with life-limiting conditions. However, it is widely acknowledged that because of how the financial system is set up, this figure did not capture all relevant expenditure and that the total spend was significantly higher. It is also acknowledged that children with life-limiting conditions, and particularly children with palliative care needs are prioritised within HSE regions. Every effort is made to care for these children to the maximum extent possible, including home care for the children and their families.

The HSE is committed to ensuring that proper governance arrangements are in place, that the care being provided is clinically sound and that those providing the care to this cohort of children are adequately trained. To this end, a working group has been established in HSE Dublin Mid-Leinster, to restructure the financial recording and reporting system, so that expenditure on home care for these children is properly accounted for. It is intended that this approach will be replicated across all four regions. In addition to this, the NDC has commenced working on the development of a model for the provision of Hospice at Home care. This is being carried out in partnership with current voluntary providers such as the IHF, Laura Lynn's Children's Hospice and the Jack & Jill Foundation.

One of the national policy recommendations was the employment of eight Children's Outreach Nurses, whose responsibilities include the facilitation of a co-ordinated support structure for children with life-limiting conditions and their families. The Nurses identify the needs of each child and ensure that families are appropriately linked in to local services. All eight nurses are now in place and are located in Drogheda, Limerick, Waterford, Temple Street and Crumlin in Dublin and in Mullingar, Cork and Galway.

The first Consultant Paediatrician with Special Interest in Paediatric Palliative Medicine has also been appointed to Crumlin Hospital. This Consultant is available to provide an advisory service to other paediatric and maternity hospitals.

The support structure for these children and their families includes health care staff across a range of disciplines. Some of these staff require additional training on working with children with life-limiting conditions. In order to address this, a national programme of continuing professional education on caring for children with life-limiting conditions has been established in partnership with the HSE, IHF and Crumlin Children's Hospital. I have arranged for the specific issues raised in the Deputy's question to be referred to the HSE for investigation and a direct reply to the Deputy.

Health Services Provision

Ceisteanna (1065)

Denis Naughten

Ceist:

1065. Deputy Denis Naughten asked the Minister for Health if he will furnish details of the numbers on waiting lists in respect of assessment and treatment for speech and language therapy, physiotherapy, and occupational therapy with a breakdown by therapy, by duration on the waiting list, by area and by age category; if he will provide corresponding figures for whole time equivalent, WTE, vacancies; and if he will make a statement on the matter. [45906/13]

Freagraí scríofa

Minister of State at the Department of Health (Deputy Alex White)

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

Question No. 1066 answered with Question No. 1057.

Medicinal Products Expenditure

Ceisteanna (1067)

Billy Kelleher

Ceist:

1067. Deputy Billy Kelleher asked the Minister for Health the net savings that will be made in 2013 from the reduction in the cost of drugs and other prescribed items; and if he will make a statement on the matter. [45991/13]

Freagraí scríofa

Minister of State at the Department of Health (Deputy Alex White)

A major new deal on the cost of drugs in the State was concluded with the Irish Pharmaceutical Healthcare Association (IPHA) in October 2012. 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 nine EU member states. The prices of a range of medicines were reduced 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. €210 million from the gross savings will be available to fund new drugs. A new agreement has also been reached with the Association of Pharmaceutical Manufacturers in Ireland (APMI), which represents the generic drugs industry. From 1 November 2012, the HSE will only reimburse generic products which are priced at 50% or less of the initial price of an originator medicine. 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.

Question No. 1068 answered with Question No. 1044.

Health Services Provision

Ceisteanna (1069)

Billy Kelleher

Ceist:

1069. Deputy Billy Kelleher asked the Minister for Health the reason the occupational therapy needs of children are being limited to two OT reviews per year, but there is no actual entitlement to therapy sessions which is a vital necessity for special needs children particularly in the early years; if he plans to change this system; and if he will make a statement on the matter. [45997/13]

Freagraí scríofa

Minister for Health

Significant resources have been invested by this country in recent years in services for children with disabilities, including those with autism. The Government is committed to the provision and development of services for these children, having regard to available resources. As the Deputy will be aware, the Health Service Executive is currently engaged in a national programme of reconfiguring therapy resources for children with disabilities, including autism, with a view to ensuring there is more equitable access to services for children, according to their individual needs. Established since 2010, the national re-configuration programme is based on the recommendations of the Report of the National Reference Group on Multidisciplinary Disability Services for Children aged 5-18.

A key objective of the HSE’s Progressing Disability Services for Children and Young People Programme (0-18 years ) is to ensure there is a clear pathway for all children to the services they need regardless of where they live, what school they go to or the nature of their disability or developmental delay. In practical terms this means that health professionals and parents will know exactly where a child should be referred and how to refer them. A fundamental principle underlying the Programme is that children should receive the health services they need as close to their home and school as possible. Some children may have their needs met by their local primary care services.

An Early Intervention Team and a School Age Team will look after all children with more complex needs in a defined geographic network area, regardless of the nature of their disability. These Teams will be supported by specialist services in areas requiring a high level of expertise. The Programme supports the principle of providing access to mainstream education where appropriate while also recognising a continuing role for special schools. The specific issue of occupational therapy reviews and therapy sessions is an operational 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.

Mental Health Services Provision

Ceisteanna (1070)

Bernard Durkan

Ceist:

1070. Deputy Bernard J. Durkan asked the Minister for Health further to parliamentary Question No.177 of 16 October 2013, in the cases of self harm presented to emergency units in 2011 with particular reference to the 316 boys and 588 girls between the ages of 10 and 17 years, the extent to which specific trends were established in the context of stabilisation following counselling and-or hospitalisation; whether any particular cause was identified as to the reason a disproportionately high number of girls relative to boys presented; whether any specific reason for this was identified or information gleaned from those presenting to emergency treatment centres on more than one occasion and the outcome; and if he will make a statement on the matter. [46008/13]

Freagraí scríofa

Minister of State at the Department of Health

As this is a service issue this matter has been referred to the HSE for direct reply.

Air Ambulance Service Provision

Ceisteanna (1071)

Denis Naughten

Ceist:

1071. Deputy Denis Naughten asked the Minister for Health the current cost to his Department, the Health Service Executive and the national ambulance service of the operation of the air ambulance service; and if he will make a statement on the matter. [46017/13]

Freagraí scríofa

Minister for Health

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.

Medicinal Products Expenditure

Ceisteanna (1072, 1075)

Jerry Buttimer

Ceist:

1072. Deputy Jerry Buttimer asked the Minister for Health the amount spent on pharmaceutical drugs at each acute hospital over each of the past ten years; and if he will make a statement on the matter. [46025/13]

Jerry Buttimer

Ceist:

1075. Deputy Jerry Buttimer asked the Minister for Health his policy on the central purchasing of drugs for all hospitals; and if he will make a statement on the matter. [46028/13]

Freagraí scríofa

Minister for Health

I propose to take Questions Nos. 1072 and 1075 together.

As these are service matters, I have asked the HSE to respond directly to the Deputy.