Wednesday, 1 Feb 2017

Written Answers Nos. 93 - 103

Rare Diseases

Ceisteanna (93)

Donnchadh Ó Laoghaire

Ceist:

93. Deputy Donnchadh Ó Laoghaire asked the Minister for Health the orphan medicines and technologies that will be considered in relation to the working group to bring forward appropriate decision criteria for the reimbursement of orphan medicines and technologies; if there are medicines earmarked that need to be evaluated under any new criteria developed; if the decision criteria will be open and transparent; the persons or bodies involved in the decision making process; and if he will make a statement on the matter. [4557/17]

Freagraí scríofa

Minister of State at the Department of Health (Deputy Marcella Corcoran Kennedy)

The HSE has advised my Department that the terms of reference for the proposed Rare Diseases Technology Review Group are being finalised. They will be discussed at an upcoming meeting of the HSE Optimising Pharmaceutical Value Group prior to being submitted to the National Drugs Management Programme Sponsorship Group for consideration.

The timeline for establishment of this group is subject to, among other things, approval of the National Drugs Management Programme Sponsorship. The Rare Disease drugs for consideration by the Rare Diseases Technology Review Group will be determined at a later stage in this process.

Home Help Service

Ceisteanna (94)

Declan Breathnach

Ceist:

94. Deputy Declan Breathnach asked the Minister for Health if there will be any increase in the number of home help hours provided in 2017 in County Louth; and if he will make a statement on the matter. [4685/17]

Freagraí scríofa

Minister of State at the Department of Health (Deputy Helen McEntee)

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

Nursing Staff Recruitment

Ceisteanna (95)

Dessie Ellis

Ceist:

95. Deputy Dessie Ellis asked the Minister for Health the status of talks on staffing, recruitment and retention in nursing and midwifery between the INMO, his department, the HSE and the Department of Public Expenditure and Reform; if he is considering special measures to address the deepening crisis with regard to staffing, recruitment and retention in nursing and midwifery; and if he will make a statement on the matter. [4561/17]

Freagraí scríofa

Minister for Health

Discussions between the INMO, SIPTU, my Department, the Department of Public Expenditure and Reform and the HSE have been ongoing over the past week in relation to nursing and midwifery recruitment and retention and the talks are continuing. The management side supplied a joint proposal document setting out a number of specific measures to attract and retain nursing staff, in addition to a funded workforce plan. The Government are already committed to 1,000 nursing posts in 2017 as part of the Programme for Partnership Government. These are fully funded and approved posts. As part of the engagement management are committed to maximising the number of additional posts that can be provided in 2017.

There are many initiatives currently underway to improve nursing and midwifery staffing levels throughout the country. The number of nursing and midwifery staff increased by 1,650 whole time equivalents between December 2013 and December 2016, notwithstanding intense global competition for our nurses and midwives. The HSE is offering permanent posts to 2016 degree programme graduates, and full time permanent contracts to those in temporary posts. The HSE is also focused on converting agency staffing to permanent posts. Its National Recruitment Service is actively operating rolling nursing recruitment campaigns. The campaigns encompass General, Mental Health, Intellectual Disability and Registered Children's Nurses, and also Midwives. The Acute Hospital Groups have advertised a number of Emergency Department nursing posts and are currently in the recruitment process.

The HSE ran a 3 day open recruitment event over the Christmas holiday period in Dr. Steevens’ Hospital for nurses and midwives from all disciplines who are interested in working in the Irish Public Health Service. 220 attended the event. 115 nursing and midwifery candidates were deemed successful and panelled following interview. The files for successful candidates have passed to the contracting unit within National Recruitment Service, Manorhamilton. This event will be followed by a series of careers events for nurses throughout 2017 with the next one scheduled for 31 March 2017. A relocation package of up to €1,500 continues to be available to nurses who return from overseas.

I wish to reassure the Deputy that all efforts are being taken to reach an agreement and to put in place arrangements that will maximise nursing and midwifery recruitment and retention.

Mental Health Guidelines

Ceisteanna (96)

Mary Lou McDonald

Ceist:

96. Deputy Mary Lou McDonald asked the Minister for Health his plans to improve communication between mental health professionals and services with the families of persons under their care in order to better treat their illness and improve recovery chances while respecting the principle of privacy and confidentiality [4635/17]

Freagraí scríofa

Minister for Communications, Climate Action and Environment (Deputy Denis Naughten)

There have been calls to involve family and carers to a greater degree in the development of care and treatment plans for those suffering with mental illness. In addition there has also been a call that family involvement in the care and treatment of such patients should be made compulsory.

The Expert Group which reviewed the Mental Health Act 2001 and published its report in 2015, looked at the former and recommended ‘proactive encouragement for the patient at all stages to involve his/her family/carer and/or chosen advocate in the admission process and in the development of the care and treatment plan with the patient’s consent'. Outcomes tend to be better when family are involved and the recommendation of the Expert Group in this regard is seen as important and is accepted by all key stakeholders. The vast bulk of patients are satisfied to allow families to be involved.

However, there are other considerations which must be taken into account where a patient reserves the right to withhold consent to share confidential information with his or her family.

Firstly, it should be clearly stated that the Medical Council’s Ethical Guide already specifically allows a doctor to ethically breach confidentiality if, for example, he/she believes that the patient is at risk of harming himself/herself or others. Doctors therefore have existing powers in exceptional circumstances and do use them where they consider it necessary. That is not to say, of course, that the prediction of risk is easy.

While encouraging family involvement in the care and treatment of mental health patients was recommended by the Expert Group, there was no recommendation that such involvement should be made compulsory against the wishes of the patient.

There may be potentially serious downsides to an absolute approach where those with mental illness may decide not to confide in their Doctor/medical team at all if they are strongly against involving family members involved for whatever reason.

I am also referring this question to the HSE for response.

Departmental Properties

Ceisteanna (97)

James Browne

Ceist:

97. Deputy James Browne asked the Minister for Health his plans for the sale of St. Senan’s psychiatric hospital; if the funds raised by the sale will be used for improving mental health services; and if he will make a statement on the matter. [4655/17]

Freagraí scríofa

Minister of State at the Department of Health (Deputy Helen McEntee)

The HSE has recently offered the property and farmland at St. Senan's Hospital in Enniscorthy for sale in two lots. Lot 1 comprises the vacant building which is about 130,000 square feet (or 12,077 square meters) in size and circa 45 acres. Lot 1 will be sold by private treaty. Lot 2 comprises about 44 acres of land and will be auctioned unless previously sold.

New replacement accommodation has already been delivered for all the mental health care services provided from St. Senan's and the delivery of health services has been discontinued at the St. Senan's site. The use of the sales proceeds from these disposals will be subject to sanction from the Department of Public Expenditure and Reform. It would be intended that the proceeds of the sale of this property will be invested in much needed mental health and other facilities in addition to the very significant Exchequer funding required to maintain and improve health infrastructure.

Since 2011, about €23 million has been raised by the HSE from the sale of mental health and other surplus assets and these proceeds have and are being invested in modernising mental facilities in line with A Vision for Change.

Primary Care Centres

Ceisteanna (98)

Maureen O'Sullivan

Ceist:

98. Deputy Maureen O'Sullivan asked the Minister for Health the revised date for full commissioning of all health services in a primary care centre in Summerhill, Dublin 1 that is currently under construction. [4525/17]

Freagraí scríofa

Minister for Health

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.

Medicinal Products

Ceisteanna (99)

Richard Boyd Barrett

Ceist:

99. Deputy Richard Boyd Barrett asked the Minister for Health the way in which parents of a child with a medical condition known to respond therapeutically to treatment with a cannabis-based product can apply to have that product made available to their child in a prompt manner; and if he will make a statement on the matter. [4616/17]

Freagraí scríofa

Minister for Health

Under the Misuse of Drugs Acts, cannabis and certain cannabis-related compounds are strictly controlled. It is open for an Irish registered doctor to apply for a licence for such preparations for an individual, named-patient under their care. Such applications will be considered on a case by case basis. The appropriateness of any particular treatment is a matter between the patient and their doctor, and the Minister for Health has no role in the patient-doctor relationship.

It would be expected that an application would be from a doctor actively involved in the treatment of their patient. The main elements of a licence application for a schedule 1 controlled drug will include:

- An outline of the treatment the patient has received to date and justification from the doctor as to why it is appropriate in their patient’s specific circumstances to prescribe a Schedule 1 drug;

- If the patient’s consultant is not the applicant, the views, if any, of the consultant in relation to the application;

- Details of the cannabis-based product which it is proposed to prescribe and administer to the patient;

- The source of the cannabis-based product;

- The arrangements for the ongoing monitoring and care of the patient once the cannabis-based treatment has commenced.

This information has been provided to individuals who contacted my Department for information and has been stated publicly by myself on a number of occasions. However, to date, just one application has been received from a doctor and following review, a licence has been granted to that doctor.

Question No. 100 answered with Question No. 59.

Health Services

Ceisteanna (101, 124)

Louise O'Reilly

Ceist:

101. Deputy Louise O'Reilly asked the Minister for Health the exact initial work that has taken place on the 2017 capacity review; the exact arrangements being put in place for the review to date; the timeline of the work of the review for 2017; and if he will make a statement on the matter. [4546/17]

John Brady

Ceist:

124. Deputy John Brady asked the Minister for Health the details of the steering group of the 2017 capacity review including membership, number of members and so on; the details of the international expert advisory group of the 2017 capacity review, including membership, number of members and so on; and if he will make a statement on the matter. [4552/17]

Freagraí scríofa

Minister for Health

I propose to take Questions Nos. 101 and 124 together.

I have confirmed that my Department will undertake a capacity review this year in line with the commitment in the Programme for a Partnership Government. I would like to assure the Deputies that this is a priority action for me and my Department.

Systematic analysis of the capacity requirements of the health service is an obvious requirement of proper planning and management. Such reviews should ideally be undertaken on a periodic basis and have a medium to long term focus. Given the changes in population, epidemiological trends and fiscal environment since the last report in 2007, a review at this stage is appropriate.

Assessing capacity requirements, however, is a complex task and cannot be divorced from considerations on the underlying model of care we want to develop for the Irish health service. It is widely acknowledged that primary care can provide more appropriate and effective management and treatment of some illnesses and conditions, especially chronic diseases. Similarly, the availability of non-acute beds and services in the community can mitigate the need for acute hospital admission, or facilitate earlier discharge. These factors directly contribute to the demands on the acute hospital system.

For this reason, I have confirmed that the review will have a wider scope than previous exercises and will examine key elements of primary and community care infrastructure in addition to hospital facilities.

The review will:

- consider current capacity in the health system and benchmark with international comparators;

- determine drivers of future demand for healthcare including demographic and epidemiological trends;

- analyse how reforms to the model of care will impact on future capacity requirements across the system; and

- provide an overall assessment of current and future capacity requirements for each year for the period 2017 – 2030.

The review is being undertaken by my Department and will be overseen by a steering group and an international expert advisory group. The steering group will include representatives from the Departments of Health, the Taoiseach and Public Expenditure and Reform, the HSE and a number of experts. This will be complemented by an independent peer group of international health experts who will be charged with reviewing and validating the review methodology and findings. Membership of both groups is being finalised, and I have asked my Department to forward details to the Deputies when representation has been confirmed.

External expert inputs will be commissioned to provide independent and impartial analysis of capacity needs. My Department will undertake a procurement process in this regard.

Given the current pressures being experienced within our hospital services, the process must also have a short-term focus and determine how capital investment over the coming years can be best targeted. I can confirm that the review will be advanced sufficiently to enable it to inform considerations around the mid-term review of the capital programme. It will be finalised for publication later in the year.

Hospital Waiting Lists

Ceisteanna (102)

Eoin Ó Broin

Ceist:

102. Deputy Eoin Ó Broin asked the Minister for Health the waiting list initiatives he is progressing; the status of further work currently being done by eHealth Ireland in relation to waiting lists; the projects being proposed and the funding required for same; and if he will make a statement on the matter. [4553/17]

Freagraí scríofa

Minister for Health

Reducing waiting times for the longest waiting patients is one of this Government's key priorities. Consequently, Budget 2017 allocated €20 million to the NTPF, rising to €55 million in 2018.

All NTPF initiatives include procedures to report on the type, nature and cost of treatments commissioned, including controls to ensure quality patient treatment, value for money and efficient processes. My Department will also implement a robust monitoring framework in this regard.

In December 2016, I granted approval to the NTPF to dedicate €5m to a daycase waiting list initiative with the aim of ensuring that no patient will be waiting more than 18 months for a daycase procedure by 30 June 2017. Around 3,000 daycases will be managed through this process and outsourcing of treatment will commence shortly.

In addition to this day case initiative, the NTPF will be working closely with my Department and the HSE to agree an approach to the remaining 2017 allocation as well as planning the approach for the significant increase in the allocation to address long waiting in 2018.

The HSE is currently developing a 2017 Waiting List Action Plan for inpatient/daycase procedures to ensure that no patient is waiting more than 15 months by the end of October. This Plan is being developed in conjunction with the NTPF's proposal for utilisation of its remaining €10m funding for patient treatment in 2017. A similar plan is being developed for outpatient appointments. I expect to make known the details of both plans in the coming weeks.

In August, following a briefing on electronic referrals, I tasked the HSE's Chief Information Officer with producing a report into how digital solutions could change the way in which waiting lists are managed.

The HSE has responded providing my Department with a detailed set of options that could be explored. This response on the digital challenge for waiting lists includes an overview of innovations and suggested approaches from over 49 suppliers, some of which have deployed successfully in other countries. The HSE has also reviewed a number of international models which will continue to be sources of information and guidance to ensure the project is well designed and delivered. The HSE has been advised to progress this issue during 2017, in conjunction with relevant business units.

The HSE is of the view that significant progress could be achieved from investing around €1.0m in technology supports. Exact expenditure would only be known following clarity on requirements, developing a business case and following the necessary public procurements.

The success of any digital solutions is predicated on high quality data flowing through the health system. The completion of the national roll-out of electronic referrals (eReferrals) and its continued growth will provide a solid data source and foundation for managing the waiting lists at individual hospital level. Also, the rollout of the Individual Health Identifier (IHI) commencing in 2017, will be important in facilitating the management of national or hospital group waiting lists, as the IHI will support the identification of patients who may be on several waiting lists for the same condition.

Health Insurance

Ceisteanna (103)

Ruth Coppinger

Ceist:

103. Deputy Ruth Coppinger asked the Minister for Health his views on health insurance companies not covering contraception; his further views on whether this is gender-based discrimination; and if he will make a statement on the matter. [4625/17]

Freagraí scríofa

Minister for Health

Under the Minimum Benefit Regulations, 1996, all health insurance products that provide cover for in-patient hospital treatment must provide a certain minimum level of benefits. The key purpose of the Regulations is to ensure the continued availability of the type of broad hospital cover traditionally held as a minimum by the insured population and to ensure that individuals do not significantly under-insure.

The regulations protect consumers by requiring insurers to offer a minimum set of benefits to every insured person. By way of example, the regulations include provision for such medical treatments as a prostatectomy or testicular biopsy (in the case of men) and cervical biopsy or maternity services (in the case of women). Insurers are free to design and sell private health insurance plans, providing the plans comply with the minimum benefit regulations. I have no role to play in commercial decisions taken by health insurers when determining whether to provide cover for any particular procedure or treatment, other than those already outlined in the regulations.