Michael Healy-Rae
Ceist:294. Deputy Michael Healy-Rae asked the Minister for Health the status of a hearing aid for a person (details supplied); and if he will make a statement on the matter. [32636/16]
Amharc ar fhreagraMedical Aids and Appliances Applications
Ceisteanna (294)
Freagraí scríofa
As this is a service matter it has been referred to the HSE for reply to the Deputy.
Services for People with Disabilities
Ceisteanna (295)
Michael Healy-Rae
Ceist:295. Deputy Michael Healy-Rae asked the Minister for Health the position regarding a laptop for a person (details supplied); and if he will make a statement on the matter. [32605/16]
Amharc ar fhreagraFreagraí scríofa
The Government is committed to providing services and supports for people with disabilities which will empower them to live independent lives, provide greater independence in accessing the services they choose, and enhance their ability to tailor the supports required to meet their needs and plan their lives. This commitment is outlined in the Programme for Partnership Government, which is guided by two principles: equality of opportunity and improving the quality of life for people with disabilities.
As the Deputy's 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.
Mental Health Services Funding
Ceisteanna (296)
Michael Healy-Rae
Ceist:296. Deputy Michael Healy-Rae asked the Minister for Health his views on correspondence (details supplied) regarding funding; and if he will make a statement on the matter. [32613/16]
Amharc ar fhreagraFreagraí scríofa
The allocation for Mental Health in 2017 will be €851.3 million, an increase of €24.7 million, or approximately 3%, over 2016. In addition, a further €50 million will be provided for the construction of the new national forensic mental health service in Portrane.
I am initiating €35 million in new services in 2017. Key priorities to be addressed in the HSE's 2017 Service Plan include youth mental health, further improvement to child and adolescent and adult services, older people's services and further enhanced out of hours response for those in need of urgent services. Recognising the time lag in new staff taking up posts and the completion of preparations for the introduction of these services, it is estimated that the revenue spend in 2017 associated with this increased allocation will be some €15 million. There will also be a further additional spend of €9.7 million in mental health associated with increased pay rates.
In relation to the section of your question regarding Mental Health Services in Kerry, we are referring this to the HSE for direct reply.
National Treatment Purchase Fund Eligibility
Ceisteanna (297)
Peter Burke
Ceist:297. Deputy Peter Burke asked the Minister for Health the way a person can access the National Treatment Purchase Fund after they have been waiting an extended period of time for an appointment; and if he will make a statement on the matter. [32646/16]
Amharc ar fhreagraFreagraí scríofa
The National Treatment Purchase Fund (NTPF) previously arranged for the provision of hospital treatment to classes of persons determined by the Minister. Since 2011 this function has been suspended. Currently, in accordance with Reg 4(1) of the NTPF Board (Establishment) Order 2004, the NTPF carries out activities in respect of data and analytics, audit and quality assurance of waiting lists and pricing under the Nursing Home Support Scheme.
The NTPF supports the management of in-patient, day-case and outpatient waiting lists by working with the HSE to assist hospitals in developing local demand and capacity planning and providing technical guidance materials to ensure the highest standard of data quality and practice. The expertise amassed by the NTPF in respect of waiting lists has proven invaluable in assisting the HSE to administer previous waiting list initiatives.
The Programme for Partnership Government emphasises the need for sustained commitment to improving waiting times for patients, with a particular focus on those patients waiting longest. 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 inpatient/daycase procedure.
In line with the Government priority, the Budget 2017 provides for the treatment of our longest-waiting patients. Funding of €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. Also within current resources, 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.
Under waiting list initiatives run by the NTPF, it liaises directly with hospitals to identify patients to be treated. The patients are then contacted to arrange the details of treatment.
Mental Health Services Provision
Ceisteanna (298)
Mick Wallace
Ceist:298. Deputy Mick Wallace asked the Minister for Health when a person (details supplied) will receive an appointment with CAMHS; the steps that can be taken to receive an appointment; the reason an appointment was cancelled; the length of the waiting list; and the place the person is on the waiting list. [32631/16]
Amharc ar fhreagraFreagraí scríofa
As this is a service issue, this question has been referred to the HSE for direct reply.
Mental Health Services Staff
Ceisteanna (299)
Brendan Griffin
Ceist:299. Deputy Brendan Griffin asked the Minister for Health his views on a matter (details supplied) regarding mental health nurses; and if he will make a statement on the matter. [32581/16]
Amharc ar fhreagraFreagraí scríofa
I have asked the HSE to respond to the Deputy directly on this matter.
Nursing Homes Support Scheme
Ceisteanna (300)
Thomas P. Broughan
Ceist:300. Deputy Thomas P. Broughan asked the Minister for Health the pricing controls in place for private nursing homes under the fair deal scheme; if all necessary services such as chiropody, and so on are included in service provision; if there are extra charges for other services and the oversight his Department has in this regard; and if he will make a statement on the matter. [32590/16]
Amharc ar fhreagraFreagraí scríofa
The Nursing Homes Support Scheme (NHSS) is a system of financial support for people who require long-term nursing home care. Participants contribute to the cost of their care according to their means while the State pays the balance of the cost.
The legislation underpinning the Nursing Homes Support Scheme (NHSS) requires each private nursing home to negotiate and agree a price for long-term residential care services with the National Treatment Purchase Fund (NTPF) should they wish to be an approved nursing home for the purposes of the Scheme. The NTPF has statutory independence in the performance of its function, and negotiates with each nursing home on an individual basis.
The NHSS covers the cost of the standard components of long-term residential care which are:
- Nursing and personal care appropriate to the level of care needs of the person;
- Bed and board;
- Basic aids and appliances necessary to assist a person with the activities of daily living; and
- Laundry service.
A person's eligibility for other schemes, such as the medical card scheme or the drugs payment scheme, is unaffected by participation in the NHSS or residence in a nursing home. Other medical or therapy services such as chiropody are not funded by the NHSS. In determining the services covered by the NHSS it was considered very important that the care recipient and the taxpayer would be protected and would not end up paying for the same services twice. For this reason, medications and aids that are already prescribed for individuals under an existing scheme are not included in the services covered by the NHSS, as this would involved effectively paying twice for the same service.
Although the NHSS covers core living expenses, residents can still incur some costs in a nursing home, e.g. social programmes, newspapers or hairdressing. In recognition of this, anyone in receipt of financial support under the NHSS retains at least 20% of their income. The minimum amount that is retained is the equivalent of 20% of the State Pension (Non-Contributory). An operator should not seek payment from residents for items which are covered by the NHSS, the medical card or any other existing scheme.
Part 7 of the Health Act 2007 (Care and Welfare of Residents in Designated Centres for Older People) Regulations 2013 stipulates that the registered provider of the nursing home must agree a contract in writing with each resident on their admission to the nursing home. This contract must include details of the services to be provided to that resident and the fees to be charged. Residents should never be charged fees which are not set out in the contract. The Department of Health and the HSE are not a party to such contracts which are concluded between each resident and their nursing home.
Registered providers of nursing home care are obliged to provide an accessible and effective complaints procedure. Concerns about additional charges should in the first instance be taken up with the nursing home provider. The Office of the Ombudsman can examine complaints about the actions of a range of public bodies and, from 24 August 2015, complaints relating to the administrative actions of private nursing homes. The Office of the Ombudsman normally only deals with a complaint once the individual has already gone through the complaints procedure of the private nursing home concerned.
The Review of the Nursing Homes Support Scheme, published in July 2015, looked at the issue of additional costs in private nursing homes and made the following recommendations:
- Nursing homes should have a published fee schedule showing all the costs associated with being a resident.
- Consideration should be given to introducing a new provision under the scheme to prohibit the levying of additional charges for any service or facility from which residents can not readily opt out without penalty while remaining as residents of that facility, or in which they cannot participate because of their level of dependency.
- Consideration should be given to including in the price contracts with facilities, details of what additional charges are proposed, of the opt-out arrangements that exist for residents and confirmation that residents will not be charged for extra services that they cannot participate in because of their dependency or lack of capacity.
An Interdepartmental/Agency Working Group has been established to progress the recommendations contained in the Review. A specific date has not been set for the Group to conclude its work, but an initial report on its progress was submitted to the Cabinet Committee on Health in September 2016.
HIQA Inspections
Ceisteanna (301, 303, 304)
Thomas P. Broughan
Ceist:301. Deputy Thomas P. Broughan asked the Minister for Health the number of HIQA inspections carried out in private nursing homes in 2013, 2014, 2015 and to date in 2016; the number of nursing homes which were required to make improvements and whether these improvements have taken place; and if he will make a statement on the matter. [32591/16]
Amharc ar fhreagraThomas P. Broughan
Ceist:303. Deputy Thomas P. Broughan asked the Minister for Health the number of HIQA inspections carried out in public nursing homes in 2013, 2014, 2015 and to date in 2016; the number of nursing homes which were required to make improvements; if these improvements have taken place; and if he will make a statement on the matter. [32592/16]
Amharc ar fhreagraThomas P. Broughan
Ceist:304. Deputy Thomas P. Broughan asked the Minister for Health the protection that exists for persons who are accessing nursing home care via the fair deal scheme when substandard care is reported by HIQA; the measures he is taking to address the standards and quality in fair deal scheme nursing homes; and if he will make a statement on the matter. [32593/16]
Amharc ar fhreagraFreagraí scríofa
I propose to take Questions Nos. 301, 303 and 304 together.
The Health Information and Quality Authority is the independent authority established under the Health Act 2007 to drive continuous improvement and to monitor safety and quality in Ireland’s health and personal social care services. Since 2009 all nursing homes - public, voluntary and private have been registered and inspected by HIQA.
The functions of the Minister for Health in relation to HIQA and the Chief Inspector of Social Services are prescribed in the Act, and in this respect the Chief Inspector is independent in the exercise of these functions.
This responsibility is underpinned by a comprehensive framework, including the National Quality Standards for Residential Care Settings for Older People and the Health Act, 2007 (Care and Welfare of Residents in Designated Centres for Older People) Regulations, 2013. New National Standards, which were approved earlier this year, are based on the legislation. The Standards set out what is expected in terms of the service provided to residents, with a focus on continuous development of safe and effective care.
It is the responsibility of HIQA to assess whether residential services are providing high quality, safe and effective services and supports to residents, and to ensure that any issues or deficits are addressed to the satisfaction of the Authority. HIQA’s programme of both scheduled and unannounced inspections helps to ensure that standards are maintained and where issues of non-compliance arise that these are addressed and rectified. The findings of all monitoring inspections are set out under a maximum of 18 outcome statements. The outcomes inspected against are dependent on the purpose of the inspection. In contrast, thematic inspections focus in detail on one or more outcomes. This focused approach facilitates services to continuously improve and achieve improved outcomes for residents of designated centres.
Following an inspection providers are required to complete an action plan, setting out how they intend to address any non-compliance found by the inspectors and a timescale for doing so. The action plan is appended to the inspection report and both are published on HIQA's website www.hiqa.ie. If a nursing home is found not to be in compliance with the Regulations it may either fail to achieve or lose its registration status. HIQA also has wide discretion in deciding whether to impose conditions of registration on nursing homes.
HIQA publishes an overview report of its regulatory programme and findings in designated centres for older persons annually. The latest report covered the period 1 January 2015 to 31 December 2015. A total of 411 nursing home inspections were carried out last year in 343 registered residential centres across the country, with almost half of all inspections being unannounced. The report sets out details of regulatory activity in respect of registration and renewals, inspection, other monitoring activities and necessary enforcement actions carried out in 2015. It also provides an analysis of the key areas of good practice and the areas that require improvement within the sector. This report is also available on HIQA's website.
I have asked HIQA for any additional information that may be available in this context and I will write to the Deputy directly with their response within the next 5 working days.
Services for People with Disabilities
Ceisteanna (302)
Catherine Murphy
Ceist:302. Deputy Catherine Murphy asked the Minister for Health the allocation of funding and personnel made to a centre (details supplied) in respect of adult services in 2014, 2015 and to date in 2016; the number of persons it was to fund; the way it proportionately compares to other adult services provided at other similar sites nationally in the same years; and if he will make a statement on the matter. [32584/16]
Amharc ar fhreagraFreagraí scríofa
The Government is committed to providing services and supports for people with disabilities which will empower them to live independent lives, provide greater independence in accessing the services they choose, and enhance their ability to tailor the supports required to meet their needs and plan their lives. This commitment is outlined in the Programme for Partnership Government, which is guided by two principles: equality of opportunity and improving the quality of life for people with disabilities.
As the issue raised by the Deputy is a service matter for the Health Service Executive (HSE), I have arranged for the question to be referred to the HSE for direct reply to the Deputy.
Questions Nos. 303 and 304 answered with Question No. 301.
Medicinal Products
Ceisteanna (305)
Seán Sherlock
Ceist:305. Deputy Sean Sherlock asked the Minister for Health the status of the drug Respreeza; his views on its use and availability; and if he will make a statement on the matter. [32652/16]
Amharc ar fhreagraFreagraí scríofa
The HSE has statutory responsibility for decisions on pricing and reimbursement of medicines 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.
The decisions on which medicines are reimbursed 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 health technology assessments (HTAs) of pharmaceutical products for the HSE, and can make recommendations on reimbursement to assist the HSE in its decision-making process.
The NCPE is currently conducting an assessment of Respreeza as maintenance treatment of emphysema in adults with documented severe alpha1-proteinase inhibitor deficiency. Once this assessment is completed, a summary report will be published on the NCPE website. The HSE will then consider the NCPE assessment as part of its decision-making process when considering the drug for reimbursement.
As the NCPE's assessment of Respreeza is ongoing, it is not possible to provide further details at this time.
Hospital Appointments Status
Ceisteanna (306)
Gerry Adams
Ceist:306. Deputy Gerry Adams asked the Minister for Health if his attention has been drawn to the case of a person (details supplied) in County Louth who is waiting for an appointment; and the timeframe for this appointment. [32657/16]
Amharc ar fhreagraFreagraí scríofa
Under the Health Act 2004, the Health Service Executive (HSE) is required to manage and deliver, or arrange to be delivered on its behalf, health and personal social services. Section 6 of the HSE Governance Act 2013 bars the Minister for Health from directing the HSE to provide a treatment or a personal service to any individual or to confer eligibility on any individual.
The scheduling of appointments for patients is a matter for the hospital to which the patient has been referred. Should a patient's general practitioner consider that the patient's condition warrants an earlier appointment, he or she should take the matter up with the consultant and the hospital involved. In relation to the specific case raised, I have asked the HSE to respond to you directly.
Hospital Appointments Status
Ceisteanna (307)
Gerry Adams
Ceist:307. Deputy Gerry Adams asked the Minister for Health if his attention has been drawn to the case of a person (details supplied) in County Louth who is awaiting hospital appointments; and the timeframe for the receipt of appointment dates. [32659/16]
Amharc ar fhreagraFreagraí scríofa
Under the Health Act 2004, the Health Service Executive (HSE) is required to manage and deliver, or arrange to be delivered on its behalf, health and personal social services. Section 6 of the HSE Governance Act 2013 bars the Minister for Health from directing the HSE to provide a treatment or a personal service to any individual or to confer eligibility on any individual.
The scheduling of appointments for patients is a matter for the hospital to which the patient has been referred. Should a patient's general practitioner consider that the patient's condition warrants an earlier appointment, he or she should take the matter up with the consultant and the hospital involved. In relation to the specific case raised, I have asked the HSE to respond to you directly.
Hospital Staff Data
Ceisteanna (308)
Fergus O'Dowd
Ceist:308. Deputy Fergus O'Dowd asked the Minister for Health further to Parliamentary Question No. 458 of 18 October 2016, the position regarding the shortage of anaesthetists in the Our Lady of Lourdes Hospital Drogheda and Louth County Hospital since 1 January 2016; the impact in terms of possible increased risk of serious medical mistakes during surgery and the possibility of delaying vital treatment for patients; the number of operations cancelled as a result since January 2016; and the number of posts vacant in the whole country at that time. [32656/16]
Amharc ar fhreagraFreagraí scríofa
Further clarification has been sought from the HSE in relation to the Deputy's question and on receipt of this further information, the details will be communicated to the Deputy.
Home Help Service Oversight
Ceisteanna (309)
Seán Fleming
Ceist:309. Deputy Sean Fleming asked the Minister for Health when a reply will issue to Parliamentary Question No. 1329 of 16 September 2016, in respect of recruitment plans for home help in counties Laois and Offaly; and if he will make a statement on the matter. [32684/16]
Amharc ar fhreagraFreagraí scríofa
As this is a service matter it has been referred to the Health service Executive for direct reply.
Nursing Home Services
Ceisteanna (310)
Seán Fleming
Ceist:310. Deputy Sean Fleming asked the Minister for Health when a reply will be received from the HSE to Parliamentary Question No. 1139 of 16 September 2016; and if he will make a statement on the matter. [32685/16]
Amharc ar fhreagraFreagraí scríofa
I propose to take Questions Nos. 309 and 310 together.
I understand a reply issued from the Health Service Executive to the Deputy on 30 September 2016.
Services for People with Disabilities
Ceisteanna (311)
Gino Kenny
Ceist:311. Deputy Gino Kenny asked the Minister for Health if his attention has been drawn to the failure of senior officers of the HSE to respond to written communications from Members of Dáil Éireann requesting meetings to address the crises in speech and language, occupational therapy and clinical psychology services for children with special needs (details supplied); and if he will make a statement on the matter. [32686/16]
Amharc ar fhreagraFreagraí scríofa
The Government is committed to providing services and supports for people with disabilities which will empower them to live independent lives, provide greater independence in accessing the services they choose, and enhance their ability to tailor the supports required to meet their needs and plan their lives. This commitment is outlined in the Programme for Partnership Government, which is guided by two principles: equality of opportunity and improving the quality of life for people with disabilities.
As the Deputy's 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.
National Lottery Funding Applications
Ceisteanna (312)
Peter Burke
Ceist:312. Deputy Peter Burke asked the Minister for Health the status of lottery funding for a group (details supplied) in County Westmeath. [32694/16]
Amharc ar fhreagraFreagraí scríofa
My Department administers a National Lottery Discretionary Fund from which once-off grants are paid to community and voluntary organisations providing a range of health related services. Funding in 2016 amounts to €3.286m of which € 585,000 has been allocated to date.
The application for funding received from the organisation referred to by the Deputy is among a large number of applications currently being assessed by my Department.
I will decide on the allocation of the remaining funds in the coming weeks. Once a decision has been made, organisations will be notified of the outcome of their application.
Health Services Provision
Ceisteanna (313)
Shane Cassells
Ceist:313. Deputy Shane Cassells asked the Minister for Health if he will address the ongoing need for medical services in south Meath and specifically in Enfield, County Meath, where a population of 4,000 persons have no access to medical services of any type; and if he will make a statement on the matter. [32696/16]
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.
Mental Health Services
Ceisteanna (314)
Shane Cassells
Ceist:314. Deputy Shane Cassells asked the Minister for Health if due to the transfer of psychiatric admission beds from Navan to Drogheda and the resultant burden put on service users and their carers, he will redraw the sector line in mental health areas to include south Meath in the Mullingar catchment area to allow accessible treatment and admission facilities for persons in south Meath; and if he will make a statement on the matter. [32698/16]
Amharc ar fhreagraFreagraí scríofa
As this is a service issue this question has been referred to the HSE for direct reply.
Hospitals Building Programme
Ceisteanna (315)
Éamon Ó Cuív
Ceist:315. Deputy Éamon Ó Cuív asked the Minister for Health when it is proposed to provide capital funding for the replacement of St. Anne’s community nursing unit and the district hospital in Clifden, Connemara, County Galway, with a new 50-bed facility to be built on the site of St. Anne’s community nursing home; and if he will make a statement on the matter. [32701/16]
Amharc ar fhreagraFreagraí scríofa
As this is a service matter it has been referred to the Health Service Executive for direct reply.
Disease Management
Ceisteanna (316)
Éamon Ó Cuív
Ceist:316. Deputy Éamon Ó Cuív asked the Minister for Health his plans to commission an independent inquiry into Lyme disease to review the evidence of the epidemiology of Lyme disease here, particularly at the level of symptoms recognition, diagnostic testing and the treatment of Lyme disease; and if he will make a statement on the matter. [32703/16]
Amharc ar fhreagraFreagraí scríofa
Lyme disease is an emerging condition which is being increasingly recognised as causing hardship, if the diagnosis is missed. Over the last number of years, there has been a marked increase in awareness of the condition among GPs and hospital doctors in Ireland. Each of the HSE’s hospital Groups have a number of Infectious Disease Consultants who are expert in the diagnosis and management of Lyme disease. Our laboratories operate to high levels of quality. Anyone who has been bitten by a tick or has other reasons to strongly suspect Lyme disease should discuss their concerns with their GP in the first instance.
Lyme borreliosis was made been statutorily notifiable in Ireland by the Infectious Diseases (Amendment Regulations) Regulations 2011 (S.I. no 452 of 2011). The notifiable entity is Lyme neuroborreliosis, the more severe neurological form of Lyme borreliosis. The Health Protection Surveillance Centre (HPSC) of the HSE collects and collates surveillance data on notifiable infectious diseases. The number of annual neuroborreliosis notifications over the last few years is as follows:
- 2012 – 8 cases;
- 2013 – 13 cases;
- 2014 – 18 cases; and
- 2015 – 12 cases.
The Weekly Infectious Disease Report, published by the HPSC on 26 October 2016, indicated that for week 42-2016 (16-10/16-22-10/16) there have been 16 cases notified so far in 2016 – an increase of 5 on the same period last year.
This gives an annual incidence rate of about 2.7 cases per million population. The number of people affected by milder forms of Lyme disease is not known. The ratio of neuroborreliosis to standard Lyme disease ranges from 5%-20%, so it is quite possible that Ireland could have between 100-200 cases of Lyme disease per annum.
HPSC Lyme Borreliosis Sub-Committee
The HPSC is responsible for the surveillance of notifiable infectious diseases such as Lyme Disease. The Scientific Advisory Committee of the HPSC has established a Lyme Borreliosis Sub-Committee, the aim of which is to develop strategies to undertake primary prevention in order to minimise the harm caused by Lyme Borreliosis in Ireland. In addition to staff from the HPSC, the membership of the Sub-Committee includes specialists in Public Health Medicine, Consultants in Infectious Diseases, Clinical Microbiology, Occupational Health an Entomologist from the Parks and Wildlife Service, a representative from the Local Government Management Agency and an Environmental Health Officer.
The Terms of Reference of the Sub-Committee are:
- To raise awareness in Ireland of Lyme Borreliosis amongst clinicians and the general public;
- To identify and highlight best international practice in raising awareness about Lyme Borreliosis for the general public;
- To develop policies of primary prevention of Lyme Borreliosis in Ireland based on best international practice;
- To explore ways in which to improve surveillance of neuroborreliosis in Ireland;
- To develop strategies to raise awareness among the general public particularly in areas of higher tick populations; and
- To produce a Final Report covering all the above areas.
The initial work of the Lyme Borreliosis Sub-committee involves a survey of laboratory methods for the diagnosis of Lyme borreliosis in Ireland, the development of Lyme borreliosis guidance for general practitioners, the publication of medical media articles to highlight diagnostics and laboratory methods relating to Lyme borreliosis available in Ireland for general practitioners, and ongoing work in drawing together the Final Report of the Sub-committee. The Sub-committee includes representation from Tick Talk, an independent Lyme disease support group set up to encourage awareness, prevention and treatment of the disease in Ireland.
The Sub-Committee first met on 6 May 2015 and it is expected to report in 2017.
Testing for Lyme Disease
Irish microbiology laboratories that test for Lyme disease all comply with internationally recognised quality assurance schemes. There schemes are designed to monitor how the laboratories operate and to ensure that the quality of laboratory reports can be guaranteed. These quality assurance schemes involve the operation of the laboratories being independently monitored and assessed by Irish and international specialist microbiology reviewers to examine the laboratories use of accredited examination procedures and methods that will ensure the highest achievable quality of all tests performed and thus to ensure that the laboratories operate to a the highest possible standards of quality.
No laboratory test will however be 100% accurate 100% of the time, and, occasionally, diagnoses can be missed, but the purpose of the quality assurance scheme for laboratories is to ensure that the likelihood of a misdiagnosis is minimised. This will involve minimising the number of false positive results (i.e. people being diagnosed as having Lyme disease when they in fact do not have the disease) and false negative results (i.e. people being diagnosed as not having Lyme disease when they in fact have the disease).
It is important that patients who are concerned about Lyme disease seek help and a firm diagnosis in Ireland. There have been many instances of patients travelling to other countries to undergo extremely expensive testing only to be given an incorrect diagnosis of Lyme disease, when they most likely had a completely unrelated condition which could be diagnosed simply and accurately within the Irish health system.
There is a real danger in looking at Lyme disease in isolation (i.e. looking at only the results of a Lyme blood test). When a doctor takes a history and examines a patient, he/she does so with an open mind. He/she is gathering evidence (in terms of the patient’s clinical history, physical examination and laboratory tests) to determine which diagnoses are most likely. It is the combination of careful clinical history, examination and appropriate laboratory testing that will lead a doctor to making a correct diagnosis.
To ensure that Lyme testing is applied in a valid and accurate, a two stage system is used.
First stage (EIA Testing): This test detects antibodies to Lyme disease (Lyme antibodies are markers that show that a person has been exposed to the bug causing Lyme disease at some stage in the past). However studies that have tested large groups (populations) of people have found that anything from 5% to 20% of these groups can have positive Lyme tests. What this means is that a significant minority people have been, at some stage in their lives, exposed to Lyme Borrelia. The initial screening EIAs can be quite inaccurate, giving false-positive reactions (i.e. the tests indicate the patient has had Lyme disease when in fact they have not). Infections such as syphilis, certain viral infections including glandular fever and certain inflammatory conditions can give positive Lyme disease tests and if these results are not double checked, the patient will have been falsely diagnosed as having Lyme disease when they in fact do not have the disease. To get around this problem, the second stage of testing – Western Blot – is used.
Second Stage (Western Blot): If a patient’s blood test results come back as being positive (or questionable) for Lyme disease, their blood is tested using the Western Blot method. Using the Western Blot greatly increases the specificity of the testing (i.e. the very specific Western Blot out-rules false positives and identifies a very high proportion of true Lyme disease cases making the two tier system very accurate).
Treatment
Lyme disease can be very successfully treated using common antibiotics. These antibiotics are effective at clearing the rash and helping to prevent the development of complications. Antibiotics are generally given for up to three weeks. If complications develop, intravenous antibiotics may be considered.
In Ireland, treatment by most clinicians is based on that laid out in evidence-based guidelines for the management of patients with Lyme disease, human granulocytic anaplasmosis (formerly known as human granulocytic ehrlichiosis), and babesiosis published by the Infectious Diseases Society of America (IDSA) in 2006. This pharmacological regime can be summarised thus:
- Doxycycline, amoxicillin or cefuroxime for the treatment of adults with early localised or early disseminated Lyme disease associated with erythema migrans, in the absence of specific neurologic manifestations (ceftriaxone in early Lyme disease for adults with acute neurologic disease manifested by meningitis or radiculopathy);
- Doxycycline, amoxicillin, or cefuroxime for adults with Lyme arthritis but without clinical evidence of neurologic disease;
- For late neurological disease in adults - intravenous ceftriaxone, cefotaxime or Penicillin G.
Prevention
Prevention is better than cure and there are a number of measures people can take to protect themselves from catching this disease. The best protection is to prevent tick bites, when walking in grassy, bushy or woodland areas, particularly between May and October:
- Arms and leg should be covered; wearing long trousers tucked into socks or boots, and long-sleeved shirts with cuffs fastened is advised. Shoes or boots should be worn rather than open-toed sandals.
- The use of insect repellent on clothes is recommended, or on limbs if it is not practicable to cover up. DEET or permethrin (insect repellents) can be used – advice can be obtained from pharmacies.
- Skin and clothing should be inspected for ticks every three to four hours and children's skin and clothes checked frequently.
- Ticks should be removed as soon as they are seen attached to the skin. Further advice on tick removal can be obtained from the HPSC website.
- It is not recommended that antibiotics are given to prevent the transmission of Lyme disease following a tick bite. Only if the area becomes inflamed may treatment be required; and advice should be sought from a doctor.
- People should see their doctor if they develop a rash or become unwell with other symptoms, letting the doctor know of exposure to ticks.
Further advice can be obtained from the HPSC website (www.hpsc.ie) and where the leaflet “Protecting Yourself Against Tick Bites and Lyme Disease” is available for the public to download.
I hope this reply has comprehensively addressed the Deputy's concerns.
Orthodontic Services
Ceisteanna (317)
Michael Fitzmaurice
Ceist:317. Deputy Michael Fitzmaurice asked the Minister for Health his plans to replace dental X-ray facilities at the orthodontic department at Merlin Park hospital, in view of the fact that children throughout counties Galway, Mayo and Roscommon have had to wait up to three years for an appointment and now find that a safe diagnostic service cannot be provided and also that the orthodontic department cannot take on any new patients; when he will replace the equipment that is necessary; and if he will make a statement on the matter. [32706/16]
Amharc ar fhreagraFreagraí scríofa
As this is a service matter it has been referred to the HSE for reply to the Deputy.