Tuesday, 14 Oct 2014

Written Answers Nos. 164-176

Health Insurance Cover

Ceisteanna (164)

Brendan Griffin

Ceist:

164. Deputy Brendan Griffin asked the Minister for Health his views on a proposal regarding private health insurance (details supplied); and if he will make a statement on the matter. [38958/14]

Freagraí scríofa

Minister for Health

The maximum waiting periods for eligibility for payment under a health insurance contract are set out in the Health Insurance Act, 2001 (Open Enrolment) Regulations 2005 and vary by age, whether medical conditions existed before the contract commenced and where the level of cover is upgraded.

Age on joining	Illnesses that commence after joining	Illnesses that commenced before joining	Accident and injuries	Maternity related claims
Under 55	26 weeks	5 years	None	52 weeks
55 – 59	52 weeks	7 years	None	52 weeks
60 – 64	52 weeks	10 years	None	52 weeks
65 and over	104 weeks	10 years	None	52 weeks

Waiting periods are applied so as to help avoid any incentive to take out health insurance immediately before treatment and to cancel it shortly afterwards. In the current system, all persons aged under 55 are covered after 26 weeks of joining for illnesses that commence after taking out health insurance. Those aged over 55 have longer waiting periods. The provisions on waiting periods help to support community rating. Under community rating, everybody is charged the same premium for a particular health insurance plan, irrespective of age, gender and the current or likely future state of their health. This system requires ‘intergenerational solidarity’, where younger people pay more for health insurance than the level of risk they present would demand, while older people pay less as a direct consequence.

The provision of waiting periods helps to encourage individuals to take out health insurance earlier in life, thus minimising the strain placed on the community rating system and ultimately benefitting the entire pool of insured persons in the community.

Question No. 165 answered with Question No. 154.

Medical Card Administration

Ceisteanna (166)

Finian McGrath

Ceist:

166. Deputy Finian McGrath asked the Minister for Health if he will provide an update on medical cards (details supplied); and if he will make a statement on the matter. [38965/14]

Freagraí scríofa

Minister of State at the Department of Health

General Practitioners (GPs) are reimbursed by the HSE's Primary Care Reimbursement Service for a range of services they provide to medical card and GP visit card holders. Under the General Medical Services (GMS) contract GPs receive a range of fees and allowances in respect of each medical card and GP visit card patient on their GMS list, including an annual capitation payment in respect of each such patient, irrespective of how many times they visit their doctor during the year. The capitation payment is based on the age and gender of the patient and if the patient is aged 70 years or more, whether they are residing in the community or in residential care.

There are also a number of additional payments, e.g. in respect of out-of-hours consultations, temporary residents, special items of services (including suturing of cuts and lacerations, recognised vein treatment, etc.), practice support allowances and payments in respect of locum expenses. The current fee and allowance rates payable to GPs under the GMS scheme are set out in S.I. 277/2013 - Health Professionals (Reduction of Payments to General Practitioners) Regulations 2013, which are available on line at: http://www.irishstatutebook.ie/2013/en/si/0277.html.

Medical indemnity insurance premia are refunded to contracted GPs based on the size of each GP's GMS panel. The HSE also pays into a superannuation scheme a sum equivalent to 10% of total capitation fees payable to contracted GPs. Payments to GPs under the National Immunisation Programmes are set out in S.I. 278/2013 - Health Professionals (Reduction of Payments to General Practitioners) (National Immunisation Programmes) Regulations 2013, which are available on line at:

http://www.irishstatutebook.ie/2013/en/si/0278.html (schedule 2 - paragraphs 3, 4, 5 and 6 refer to payments to GPs for vaccinations under the GMS scheme).

Medical Card Applications

Ceisteanna (167)

Finian McGrath

Ceist:

167. Deputy Finian McGrath asked the Minister for Health the position regarding a medical card application in respect of persons (details supplied) in Dublin 13; and if he will make a statement on the matter. [38966/14]

Freagraí scríofa

Minister of State at the Department of Health

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.

Speech and Language Therapy

Ceisteanna (168)

Billy Kelleher

Ceist:

168. Deputy Billy Kelleher asked the Minister for Health if he will provide, in tabular form, for each local health office; the number of children currently awaiting an initial assessment for speech and language therapy for the following waiting times, birth to four months, four to eight months, eight to 12 months, 12 to 18 months, 18 to 24 months, more than 24 months; and the same details for the open waiting list. [38978/14]

Freagraí scríofa

Minister of State at the Department of Health

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

Hospital Staff Data

Ceisteanna (169)

Billy Kelleher

Ceist:

169. Deputy Billy Kelleher asked the Minister for Health if he will provide in tabular form the most up to date figures for the number of positions in each public/voluntary hospital in the following categories; consultants, non-consultant hospital doctors, nursing positions, other health and social care professionals, management-administration, general support staff; and the number of vacant positions in each public-voluntary hospital for the same positions. [38979/14]

Freagraí scríofa

Minister for Health

As I have no direct role in this matter, I have asked the HSE to respond to the Deputy directly.

Medical Card Data

Ceisteanna (170)

Billy Kelleher

Ceist:

170. Deputy Billy Kelleher asked the Minister for Health if he will provide in tabular form for September 2013 and September 2014 for each local health area the number of medical cards in circulation; the number of which are issued on the basis of the exercise of discretion; and the number of which are allocated to over 70s. [38980/14]

Freagraí scríofa

Minister of State at the Department of Health

The following table sets out the information requested by the Deputy.

	Numbers at 1 Sept 2013				Numbers at 1 Sept 2014
Local Health Office	Medical Cards	Of which Discretionary	Over 70s Medical Cards	Of which Discretionary	Medical Cards	Of which Discretionary	Over 70s Medical Cards	Of which Discretionary
Carlow/ Kilkenny	61,405	1,494	10,636	131	59,510	2,015	10,130	148
Cavan/ Monaghan	59,943	1,048	10,472	51	57,809	1,554	10,152	82
Clare	49,923	2,054	9,414	341	46,777	2,377	9,009	300
Cork - North Lee	81,753	4,015	13,617	308	78,876	4,595	13,320	335
Cork - South Lee	63,063	2,353	14,710	251	61,039	2,872	13,669	256
Donegal	91,013	1,836	14,257	84	88,141	2,601	14,186	158
Dublin North Central	53,136	959	11,891	111	54,552	1,327	10,981	137
Dublin South City	38,355	645	8,876	62	37,273	844	7,901	86
Dublin South East	24,330	507	9,026	59	23,348	668	7,684	95
Dublin South West	68,199	1,782	11,908	111	66,560	2,020	11,348	150
Dublin West	62,150	1,193	7,595	36	60,740	1,577	7,311	63
Dun Laoghaire	25,121	566	10,471	85	22,572	687	8,506	103
Galway	104,354	2,566	19,037	75	99,423	3,368	18,274	124
Kerry	61,303	2,164	13,219	193	59,949	2,737	12,749	214
Kildare/ West Wicklow	76,794	2,694	11,701	160	74,433	3,252	11,334	209
Laois/ Offaly	70,609	2,825	11,407	223	68,896	3,372	11,073	233
Limerick	80,895	2,882	15,403	494	78,286	3,385	14,627	457
Longford/ Westmeath	57,292	1,392	9,695	91	56,453	1,932	9,294	124
Louth	61,894	729	9,759	41	60,494	1,191	9,462	66
Mayo	67,218	1,439	13,151	46	64,123	2,008	12,842	68
Meath	68,441	908	10,543	41	66,246	1,540	10,311	61
North Cork	36,741	2,289	7,629	103	34,262	2,517	7,302	133
North Dublin	81,503	2,518	17,332	301	77,379	3,242	16,224	370
North Tipp./ East Limerick	30,973	1,755	6,431	197	29,701	1,868	6,236	197
North West Dublin	70,587	1,222	11,198	90	66,333	1,714	10,309	121
Roscommon	30,695	988	6,403	58	29,377	1,200	6,228	81
Sligo/ Leitrim	43,384	1,651	9,080	72	41,899	1,960	8,738	116
South Tipperary	42,762	1,770	8,298	192	41,429	2,012	7,953	160
Waterford	58,531	2,019	10,695	200	55,805	2,440	10,131	162
West Cork	22,110	1,008	5,755	73	21,058	1,202	5,493	86
Wexford	71,817	1,428	12,327	67	69,831	2,043	11,970	97
Wicklow	46,768	1,189	8,479	68	45,237	1,452	8,125	86
Total National	1,863,062	53,888	350,415	4,415	1,797,811	67,572	332,872	5,078

Medical Card Data

Ceisteanna (171)

Denis Naughten

Ceist:

171. Deputy Denis Naughten asked the Minister for Health the percentage of medical cards that are processed within 15 days, 30 days, 45 days, 60 days and in excess of 60 days; the corresponding figures for discretionary medical cards and over 70s' cards; the average processing time for each category of card; and if he will make a statement on the matter. [39001/14]

Freagraí scríofa

Minister of State at the Department of Health

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.

Medical Card Eligibility

Ceisteanna (172)

Derek Nolan

Ceist:

172. Deputy Derek Nolan asked the Minister for Health the reason the decision to return discretionary medical cards to those who had them withdrawn, as announced in June 2014, did not apply to a former medical card holder (details supplied) in County Galway; and if he will make a statement on the matter. [39010/14]

Freagraí scríofa

Minister of State at the Department of Health

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.

Medical Indemnity Cover

Ceisteanna (173, 177, 188)

Finian McGrath

Ceist:

173. Deputy Finian McGrath asked the Minister for Health the position regarding the removal of indemnity cover in respect of a person (details supplied); the reason for same; and if he will make a statement on the matter. [39014/14]

Billy Timmins

Ceist:

177. Deputy Billy Timmins asked the Minister for Health his views on correspondence (details supplied); and if he will make a statement on the matter. [39042/14]

Thomas Pringle

Ceist:

188. Deputy Thomas Pringle asked the Minister for Health if a person's (details supplied) indemnity, which was removed by the Health Service Executive, will be reinstated; and if he will make a statement on the matter. [39126/14]

Freagraí scríofa

Minister for Health

I propose to take Questions Nos. 173, 177 and 188 together.

This matter is sub-judice and I am therefore restricted in the response I can give to your question.

My role as Minister for health primarily relates to national policy decisions, legislation, implementing the programme for government and securing an overall budget for health and accounting for it to the Oireachtas. I am in no way personally involved in decisions about individual patients, members of staff or contractors. I have had no role in this matter which is one for the HSE and it would be inappropriate for me to intervene regardless of political pressure or lobbying. I hope you can understand and respect why that is.

With regard to this case, I understand from the HSE that her indemnity has been suspended temporarily due to specific and serious concerns expressed by other clinical staff about patient safety. When the HSE suspends an individual as precautionary measure subject to a review/investigation, it does not do so lightly. An overall competence and performance review is planned. I hope this be done as expediently as possible.

On the broader issue, pregnancy is not a disease but a physiological condition and there is no reason why women with a normal pregnancy, should not have their baby delivered at home by a community midwife or in a midwife-led unit. It should be a mother’s choice within safe guidelines. This will form part of the general review of maternity services being carried out over the course of the next twelve months.

Hospital Waiting Lists

Ceisteanna (174)

Tom Fleming

Ceist:

174. Deputy Tom Fleming asked the Minister for Health if he will expedite an appointment in respect of a person (details supplied) in County Kerry; and if he will make a statement on the matter. [39022/14]

Freagraí scríofa

Minister for Health

The National Waiting List Management Policy, A standardised approach to managing scheduled care treatment for in-patient, day case and planned procedures, January 2014, 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 been adopted by the Health Service Executive, sets out the processes that hospitals are to implement to manage waiting lists.

In relation to the particular query raised by the Deputy, I have asked the HSE to respond directly to him on this matter.

Tobacco Control Measures

Ceisteanna (175)

Dara Calleary

Ceist:

175. Deputy Dara Calleary asked the Minister for Health in view of the differentiation within the EU tobacco products directive between cigars and cigarettes, the fact that the cigar smoking rate is 0.9%, the proposals of the UK Department of Health to exclude specialist tobacco products from its packaging legislation, his views on exempting cigar packaging from the Public Health (Standardised Packaging of Tobacco) Bill 2014; and if he will make a statement on the matter. [39025/14]

Freagraí scríofa

Minister for Health

As the Deputy will be aware, the Public Health (Standardised Packaging of Tobacco) Bill 2014 covers all tobacco products legally available for retail sale in Ireland. All tobacco products have been shown to negatively affect health and as such it was considered appropriate that all tobacco products should be treated equally under the Bill.

The preamble to the World Health Organisation Framework Convention for Tobacco Control (WHO FCTC), which Ireland has signed and ratified, states that there is no distinction made between tobacco products and the harm that they cause. Article 11 of the FCTC concerns the packaging and labelling of tobacco products, and the guidelines issued by the WHO for its implementation request that Parties to the Treaty consider adopting standardised packaging for all tobacco products: “Parties should ensure that the packaging and labelling provisions related to Article 11 of the Convention apply equally to all tobacco products sold within the jurisdiction.”

There is a wealth of experience internationally that shows the necessity for a comprehensive approach in tobacco control. The evidence base shows that standardised packaging will impact on the consumption of tobacco products, including cigars, in that it will reduce the appeal of tobacco products and will encourage cessation, whilst at the same time reducing the ability of the packaging of each of these products to mislead consumers about the harmful effects of smoking.

As Deputy has pointed out, the UK has not included cigars and pipe tobacco in their draft standardised packaging regulations. If the UK decides to go ahead with this initiative the resulting regulations will be made under their Children and Families Act 2014. The proposed Irish legislation is not confined to any specific age group. From a public health perspective, Ireland has taken the decision to reduce smoking of all tobacco products, and not just cigarettes, to a prevalence rate of less than 5% by 2025. All smokers, irrespective of the type of product they consume deserve the same level of protection as do those who consume cigarettes. The standardised or plain packaging legislation already introduced in Australia covers all tobacco products, including cigars.

Mental Health Services Funding

Ceisteanna (176)

Finian McGrath

Ceist:

176. Deputy Finian McGrath asked the Minister for Health the position regarding mental health and additional resources for front-line mental health care services (details supplied); and if he will make a statement on the matter. [39034/14]

Freagraí scríofa

Minister of State at the Department of Health

Dealing with the current high levels of suicide and deliberate self-harm and the reform of our mental health services are two priority areas for the Government. In line with Programme for Government commitments, €90 million and some 1,100 additional posts have been provided since 2012, to develop Community Mental Health Teams and Suicide Prevention resources. In addition, the budget for the National Office for Suicide Prevention (NOSP) has more than doubled, from €4 million in 2011 to €8.8 million in 2014.

The NOSP has primary responsibility for the implementation, monitoring and evaluation of Reach Out our suicide prevention strategy and has been tasked with coordinating suicide prevention efforts around the country as well as supporting agencies and individuals interested and active in suicide prevention. The NOSP funds over thirty non-governmental organisations to carry out an array of work in communities that promote positive mental health and work to reduce the incidence of suicide and self-harm. In 2014, the NOSP will continue to work in partnership to deliver local and community based supports as well as frontline services. The NOSP is also working to improve access to information and supports for anyone experiencing mental health difficulties with the development of the free to call Samaritans 116 123 helpline number which was launched earlier this year, and a new on-line portal, which will be launched shortly, that will provide easily accessible and accurate information. These new initiatives will simplify the signposting to services for people who may be going through tough times.

In recognition of the need to further improve the response of the Mental Health Service to people following an episode of deliberate self harm, the HSE, in conjunction with the Irish College of Psychiatrists, has developed a Clinical Programme. An important aspect of the Programme is to ensure each person is linked in to the follow up recommended by the nurse. Thirty five posts have been allocated on the basis of the number of self harm presentations to the various Emergency Departments; twenty two of these posts are currently filled and training has been initiated. In addition, the Suicide Crisis Assessment Nurse (SCAN) initiative is being extended to eight new sites across the country and will be operational by the end of the year. This service provides active liaison between primary care and the mental health services and enables and assists GPs in carrying out speedy clinical assessments of patients presenting with deliberate self harm/suicide crisis.

Mindful that schools are one of the key settings for the promotion of mental health and well-being of young people and that they are also in the position to identify young people experiencing emotional difficulties, the NOSP worked closely with the Department of Education and Skills to develop Guidelines for Mental Health Promotion and Suicide Prevention in post-primary schools.

The Department of Health and the NOSP are continuing to work very closely on suicide prevention issues and on the finalisation of a new Strategic Framework which is expected to be completed by the end of the year.

The Report of the Expert Group on Mental Health Policy (2006), A Vision for Change, provides a framework for action to develop a modern high quality mental health service over a 7 to 10 year period. Implementation of Vision has included positive mental health promotion, accelerated closure of the old psychiatric hospitals, the development of community based adult and child and adolescent services and bespoke new facilities to support the recommended community-based, recovery-focussed model of care resulting in shorter episodes of in-patient care and the adoption of a recovery approach in the delivery of services.

The Child and Adolescent Mental Health Service is a key Service Improvement Project for the HSE. The project aims to improve access to and use of CAMHS in-patient, day hospital and community based services, particularly in the context of agreed protocols governing the area of 16-17 year olds. As part of the development funding prioritised by this Government since 2012 for mental health overall, upwards of 230 new posts have been allocated to Child and Adolescent Community Mental Health Teams. This additional investment is intended to enable CAMHS teams to cater for all age ranges up to 18 years. Area Mental Health Management Teams are now also in place across the country, to ensure a more seamless service between CAMHS and Adult Mental Health services.