Michael Healy-Rae
Ceist:50. Deputy Michael Healy-Rae asked the Minister for Health his views on a matter (details supplied) regarding medical card refusals; and if he will make a statement on the matter. [30303/16]
Amharc ar fhreagraMedical Card Administration
Ceisteanna (50)
Freagraí scríofa
Under the Health Act, 1970, medical cards are provided to persons who are, in the opinion of the HSE, unable without undue hardship to arrange GP services for themselves and their dependants and every application must be assessed on that basis. In accordance with the Act, the assessment for a medical card is determined primarily by reference to the means, including the income and expenditure, of the applicant and his or her partner and dependants. Where deemed appropriate in particular circumstances, the HSE may exercise discretion and grant a medical card even though an applicant exceeds the income guidelines but where they may face difficult financial circumstances, such as extra costs arising from illness.
It should be noted that every effort is made by the HSE, within the framework of the legislation, to support applicants in applying for a medical card and, in particular, to take full account of the difficult circumstances in the case of applicants who may be in excess of the income guidelines.
Social and medical issues are considered when determining whether undue hardship exists for an individual accessing general practitioner or other medical services. The HSE affords applicants the opportunity to furnish supporting information and documentation to fully take account of all the relevant circumstances that may benefit them in the assessment, including medical evidence of cost and necessary expenses.
It is important that people with medical needs should be able to access necessary assistance in a straight forward manner. It is clear greater discretion is being exercised by the HSE because the number of discretionary medical cards in circulation has increased from about 52,000 in mid-2014 to over 110,453 as of 1 September this year. This followed the measures announced by my predecessor Minister Varadkar, when the "Keane" Report of the Expert Panel on Medical Need for Medical Card Eligibility was published. The "Keane" Report found that it is not feasible, desirable or ethically justifiable to list medical conditions for medical card eligibility. On foot of the publication of the report, the HSE established a Clinical Advisory Group to develop clinical oversight and guidance for the operation of a more compassionate and trusted medical card system. Its establishment followed the completion of the work of the Expert Panel on Medical Need for Medical Card Eligibility and demonstrates the HSE's commitment to the development of a medical system which is responsive and considerate of an applicant's particular circumstances.
Hospital Waiting Lists
Ceisteanna (51)
John Brady
Ceist:51. Deputy John Brady asked the Minister for Health the strategy and funding in place to ensure that the waiting list for scoliosis patients is reduced; the status of the recruitment of a further additional orthopaedic surgeon and the new theatre that is currently being commissioned at Our Lady's Children's Hospital, Crumlin; if any consideration is being given to early detection and monitoring processes for children in order to avoid complex surgeries in the future; and if he will make a statement on the matter. [30504/16]
Amharc ar fhreagraFreagraí scríofa
Scoliosis affects approximately 1% of children and adolescents in Ireland. The management of scoliosis is complex and is determined by the severity of the curvature and skeletal maturity.
Long waiting times for scoliosis surgery are not acceptable, and my Department has been working closely with the HSE to address services pressures, particularly in Our Lady's Children's Hospital Crumlin, which is the largest provider of scoliosis surgery for children and young people. Additional funding of €1.042m was allocated under the 2015 Service Plan to increase capacity at Crumlin, and an additional orthopaedic surgeon, anaesthetist, and support staff, are now in place with recruitment of a further additional orthopaedic surgeon underway.
Capital funding was also provided for a new theatre on site to expand theatre capacity further, and this is currently being commissioned. The Children's Hospital Group is proactively working on nurse recruitment to support the opening of the new theatre.
The HSE Winter Initiative 2016-2017, published on 9 September, also includes €2m provided specifically for scoliosis patients to treat 39 adolescent patients on the Tallaght waiting list and an additional 15-20 paediatric patients from the Crumlin waiting list by year end.
I recently met with a number of scoliosis advocacy groups to discuss their concerns and my Department will continue to work with the HSE and the relevant hospitals to ensure improvements in access to spinal surgery.
In relation to early detection and monitoring processes for children, as this is service matter, I have asked the HSE to respond to you directly.
Health Services Provision
Ceisteanna (52, 80)
Mary Butler
Ceist:52. Deputy Mary Butler asked the Minister for Health the reason his Department briefed against the expansion of cardiac services in Waterford prior to the undertaking of the Herity review. [30684/16]
Amharc ar fhreagraMary Butler
Ceist:80. Deputy Mary Butler asked the Minister for Health if he will meet with consultants from the south east to discuss the provision of cardiac services at Waterford University Hospital. [30685/16]
Amharc ar fhreagraFreagraí scríofa
I propose to take Questions Nos. 52 and 80 together.
As the Deputy will be aware, the Programme for a Partnership Government committed to the development of a second Cath Lab in University Hospital Waterford, (UHW) subject to a favourable recommendation from an independent clinical review of the needs of the region. The review was undertaken by Dr Niall Herity, a highly respected, Belfast based NHS cardiologist. It is a comprehensive report which reflects the fact that Dr Herity consulted widely and met with all of the key stakeholders including the management and staff of both UHW and Cork University Hospital. Both the views of my Department and the HSE on the investment priorities for the South/South West Hospital Group fed into the review, as did their views on the sustainability of a second Cath Lab in the context of international guidance on population levels and procedure numbers.
Dr Herity has made clear recommendations that a second cardiac cath lab at UHW is not justified and I accept this. However, he recommends investing in UHW to enhance the existing cardiology services including increasing the number of weekly sessions currently provided, in order to address waiting times and to provide improved access for patients. He also recommends that new specialist equipment be provided to improve contingency for radiological equipment failure during a procedure. I am happy to provide the additional resources necessary to implement these recommendations. This investment will be reflected in the HSE National Service Plan for 2017. During this period of investment and enhancement of services, the situation will be closely monitored. A review will be carried out in early 2017 to assess the impact that these improvements have had on the volume of patients attending the cath lab.
Dr Herity also recommends that some services be provided elsewhere. I want to be certain that any change to how a service is delivered will result in improved services for the patients using that service. Therefore, I have asked my Department to address the implications of ceasing primary PCI services at UHW by undertaking a national review of all primary PCI services with the aim to ensure that as many patients as possible have access to a 24/7 basis to safe and sustainable emergency interventions following a heart attack. I expect the review to be completed by the end of July 2017.
I intend to visit UHW next month and I will take the opportunity to speak with staff and management on a broad range of issues.
Medicinal Products Prices
Ceisteanna (53)
Gino Kenny
Ceist:53. Deputy Gino Kenny asked the Minister for Health the efforts he is making to secure cost-effective prescribing, pricing and payment systems; the reason the cost of drugs here is greater than in comparable countries; and if he will make a statement on the matter. [30692/16]
Amharc ar fhreagraFreagraí scríofa
The State has introduced a series of reforms in recent years to reduce pharmaceutical prices and expenditure.
A new four-year Framework Agreement on the Supply and Pricing of Medicines was signed in July 2016 with the Irish Pharmaceutical Healthcare Association (IPHA) which is expected to deliver approximately €600 million in savings over the lifetime of the Agreement. The principles captured in the Agreement will also be extended to non-IPHA suppliers of branded medicines, leading to additional expected savings in the region of €150 million.
The new Agreement contains a number of features which represent clear additional value over the terms of the previous 2012 Agreement. The reference basket of countries used to set prices in Ireland has been expanded from 9 to 14 countries and, importantly, includes lower cost countries. For the first time, the Agreement provides for an annual price realignment, which will ensure that the prices of medicines in Ireland reduce in line with price reductions across the reference countries. This will ensure the State achieves better value for money on the cost of medicines as prices in other basket countries are adjusted downwards over time. In addition, the Agreement secured a 30% reduction in the price of biologic medicines when a biosimilar medicine enters the market.
Another important initiative is the on-going implementation of generic substitution and reference pricing. To date 47 substances have been included in this process and I have recently requested that the Health Products Regulatory Authority review an additional 15 substances. The implementation of generic substitution and reference pricing delivered €47m in savings in 2014 and €94m in savings in 2015.
My Department and the HSE are committed to driving further efficiencies and savings on the cost of medicines for the State. Establishing a new Community Pharmacy, Dental, Optical and Aural Policy unit in the Department is bringing a renewed focus to the development of policy in relation to community pharmacy and the issues associated with achieving maximum benefit to patients.
The HSE has also recently established a Drugs Management Portfolio, which includes a range of projects to optimise value in the primary care and hospital settings. The Portfolio also includes the work of the HSE's Medicines Management Programme which introduced the preferred drugs initiative to facilitate more cost-effective prescribing particularly in relation to high-cost medicines. It continues to engage with general practitioners to reinforce the message around safe, effective and cost-effective prescribing including generic prescribing.
It is also important to point out that the prices of medicines vary between countries for a number of reasons, including different prices set by manufacturers, different wholesale and pharmacy mark-ups, different dispensing fees and different rates of VAT.
National Treatment Purchase Fund Waiting Times
Ceisteanna (54)
Anne Rabbitte
Ceist:54. Deputy Anne Rabbitte asked the Minister for Health his views on the September 2016 figures from the National Treatment Purchase Fund which showed that 1,805 persons are waiting more than 18 months for an outpatient appointment in Galway University Hospital; and if he will make a statement on the matter. [30653/16]
Amharc ar fhreagraFreagraí scríofa
A key challenge for our health system is to ensure that patients have timely access to health services, in light of increasing demand. This Government is committed to a sustained focus on improving wait times, particularly for those waiting longest.
While the numbers on waiting lists are undoubtedly too high, the key issue is how long people are waiting. According to the September waiting list data published by the NTPF, 83% of patients on the outpatient waiting lists for Galway University Hospital are waiting less than 12 months for their appointment and nearly 90% are waiting less than 15 months.
My Department works closely with the HSE and the NTPF to implement measures to reduce waiting times. At my request, in August, the HSE developed an action plan to reduce, by year end, the number of patients currently waiting 18 months or more for an impatient / daycase procedure.
Also the NTPF is currently implementing an Endoscopy Initiative which aims to ensure that, by year end, no patient will be waiting 12 months or more for an endoscopy procedure.
Furthermore, €7m of the Winter Initiative funding is to be utilised to fund a targeted waiting list programme to provide treatment for patients waiting for orthopaedic, spinal and scoliosis procedures.
Finally, the Budget 2017 provides for the treatment of our longest-waiting patients. €20m is being allocated to the NTPF, rising to €55m in 2018. Planning of this initiative is at an advanced stage by the NTPF, my Department and the HSE.
In relation to the specific query raised, as this is a service matter, I have asked the HSE to respond to you directly.
National Treatment Purchase Fund Waiting Times
Ceisteanna (55)
John Lahart
Ceist:55. Deputy John Lahart asked the Minister for Health his views on the September 2016 figures from the National Treatment Purchase Fund which showed that 2,048 persons are waiting more than 18 months for an outpatient appointment in Tallaght hospital; and if he will make a statement on the matter. [30654/16]
Amharc ar fhreagraFreagraí scríofa
A key challenge for our health system is to ensure that patients have timely access to health services, in light of increasing demand. This Government is committed to a sustained focus on improving wait times, particularly for those waiting longest.
While the numbers on waiting lists are undoubtedly too high, the key issue is how long people are waiting. According to the September waiting list data published by the NTPF, 79% of patients on the outpatient waiting list for Tallaght Hospital are waiting less than 12 months for their appointment and nearly 87% are waiting less than 15 months.
My Department works closely with the HSE and the NTPF to implement measures to reduce waiting times. At my request, in August, the HSE developed an action plan to reduce, by year end, the number of patients currently waiting 18 months or more for an impatient / daycase procedure.
Also the NTPF is currently implementing an Endoscopy Initiative which aims to ensure that, by year end, no patient will be waiting 12 months or more for an endoscopy procedure.
Furthermore, €7m of the Winter Initiative funding is to be utilised to fund a targeted waiting list programme to provide treatment for patients waiting for orthopaedic, spinal and scoliosis procedures.
Finally, the Budget 2017 provides for the treatment of our longest-waiting patients. €20m is being allocated to the NTPF, rising to €55m in 2018. Planning of this initiative is at an advanced stage by the NTPF, my Department and the HSE.
In relation to the specific query raised, as this is a service matter, I have asked the HSE to respond to you directly.
Health Services Provision
Ceisteanna (56)
Michael Healy-Rae
Ceist:56. Deputy Michael Healy-Rae asked the Minister for Health his views on correspondence (details supplied) regarding cataract operations; and if he will make a statement on the matter. [30302/16]
Amharc ar fhreagraFreagraí scríofa
The Primary Care Eye Services Review Group, which was established by the HSE, is currently finalising an implementation plan to support its review. The overall aim of the Review Group is to shift the management of many eye conditions from acute care services to primary care and community services, as appropriate.
The Government is committed to updating the national eye care plan, including evaluation of the Sligo model for cataract surgery. These are matters which I intend to consider in the context of the implementation of the health commitments in the Programme for a Partnership Government and having regard to the funding available to facilitate such measures.
With regard to the specific queries raised by the Deputy, as this is a service matter I have asked the HSE to respond to you directly.
Medicinal Products Availability
Ceisteanna (57)
Carol Nolan
Ceist:57. Deputy Carol Nolan asked the Minister for Health the status of the assessment by the HSE of the NCPE, National Centre for Pharmacoeconomics, health technology assessment of ataluren brand name (details supplied); when a decision on the funding of this drug will be taken by the HSE as to whether to include it in the reimbursement list; and if he will make a statement on the matter. [30505/16]
Amharc ar fhreagraFreagraí scríofa
The HSE has statutory responsibility for decisions on pricing and reimbursement of medicinal products under the community drugs schemes, in accordance with the Health (Pricing and Supply of Medical Goods) Act 2013. Prior to deciding whether to reimburse a medicine, the HSE considers a range of statutory criteria, including clinical need, cost-effectiveness and the resources available to the HSE.
Decisions on whether to reimburse medicines by the taxpayer are made on objective, scientific and economic grounds by the HSE, on the advice of the National Centre for Pharmacoeconomics (NCPE). The NCPE conducts the health technology assessment of pharmaceutical products for the HSE, and can make recommendations on reimbursement to assist the HSE in its decision-making process.
The NCPE completed a health technology assessment of ataluren (brand name Translarna) in April and did not recommend reimbursement. I have asked the HSE to reply directly to the Deputy regarding the latest position on this drug.
Primary Care Centres Expenditure
Ceisteanna (58)
Gino Kenny
Ceist:58. Deputy Gino Kenny asked the Minister for Health the percentage of the health budget that is spent on primary care, in particular general practitioners' primary care centres, and allied professionals working in primary care such as occupational therapists and dieticians; and if he will make a statement on the matter. [30690/16]
Amharc ar fhreagraFreagraí scríofa
As this question relates to service matters, I have arranged for the question to be referred to the Health Service Executive (HSE) for direct reply to the Deputy.
Hospital Waiting Lists
Ceisteanna (59, 95)
Aindrias Moynihan
Ceist:59. Deputy Aindrias Moynihan asked the Minister for Health his plans to reduce gynaecology waiting times for inpatient and day cases in Cork University Hospital. [30663/16]
Amharc ar fhreagraAindrias Moynihan
Ceist:95. Deputy Aindrias Moynihan asked the Minister for Health the number of persons waiting more than a year for an outpatient consultation with a gynaecologist at Cork University Hospital. [30662/16]
Amharc ar fhreagraFreagraí scríofa
I propose to take Questions Nos. 59 and 95 together.
A key challenge for our health system is to ensure that patients have timely access to health services, in light of increasing demand. This Government is committed to a sustained focus on improving wait times, particularly for those waiting longest.
While the numbers on waiting lists are undoubtedly too high, the key issue is how long people are waiting. According to the September waiting list data published by the NTPF, 1,556 patients are waiting over 12 months.
My Department works closely with the HSE and the NTPF to implement measures to reduce waiting times. At my request, in August, the HSE developed an action plan to reduce, by year end, the number of patients currently waiting 18 months or more for an impatient / daycase procedure.
Finally, the Budget 2017 provides for the treatment of our longest-waiting patients. €20m is being allocated to the NTPF, rising to €55m in 2018. Planning of this initiative is at an advanced stage by the NTPF, my Department and the HSE.
In relation to the specific query raised by the Deputy, as this is a service matter I have asked the HSE to respond to you directly.