Questions Nos. 1 to 9, inclusive, answered orally.

Questions Nos. 10 to 13, inclusive, resubmitted.

Questions Nos. 14 to 24, inclusive, answered orally.

Mental Health Services Provision

Ceisteanna (25)

Bernard Durkan

Ceist:

25. Deputy Bernard J. Durkan asked the Minister for Health the extent to which he remains satisfied that adequate resources remain available for child psychology and psychiatry services, with particular reference to early intervention and identification of the relevant and appropriate supports, thereby making available an adequate suite of services to meet the growing requirements evenly throughout the country; the results of any analysis that has been undertaken to identify possible weaknesses in the services over the past number of years; the steps required to improve the services; and if he will make a statement on the matter. [7031/17]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

A Vision for Change recognises a ‘pivotal role’ for primary care in providing mental health services. The policy assigns a key role to GPs for access to specialist mental health services. GPs can detect and diagnose mental health difficulties and either treat the individual or refer him/her to other professionals within primary care or to specialist services, based on identified need. The policy recommends a consultation/liaison model between primary care and mental health services, and the HSE has actively progressed communication and integration between primary and secondary mental health services through the use of a “Stepped Care” approach. Psychological and other relevant supports are accessed in primary care in the first instance, with CAMHS providing a specialist secondary care service to those referred to it.

Primary Care services are usually the first point of contact for children and adolescents when problems initially present, where those with mild to moderate presentations are seen by Psychologists in the service. They are not usually associated with significant risk of harm, unless there is a rapid deterioration or a crisis occurs. The availability of Early Intervention Services within Primary Care ensures timely and appropriate intervention.

In line with the commitment to develop early intervention services for those under 18, €5 million has been allocated to recruit 114 Assistant Psychologists in primary care. This will enhance the primary care response and help to reduce waiting lists for child and adolescent mental health services. Recruitment arrangements for these posts are currently being finalised by the HSE in conjunction with my Department and the Department of Expenditure and Reform.

The HSE Mental Health Division currently employs approximately 213 Psychologists with 67 of these operating within Child and Adolescent Mental Health Services. A further 60 psychology students participate as members of community based mental health teams providing services to children and adults. In addition, the HSE currently funds a number of agencies to provide a variety of counselling services to young people. This includes 10 existing Jigsaw sites nationally together with further planned expansion of this service for 2017 with two additional sites in both Cork and Dublin and a further site in Limerick.

In conclusion very significant efforts are underway to expand access and I am satisfied that good progress is being made to deliver improved and more consistent mental health services for young people, reflecting the significant resources provided by this Government in this area.

National Children's Hospital Expenditure

Ceisteanna (26)

David Cullinane

Ceist:

26. Deputy David Cullinane asked the Minister for Health the additional funding stream which has been allocated to his Department for 2017 and 2018 to cover the cost of the national children's hospital in view of public comments by the Minister for Public Expenditure and Reform on funding for the national children's hospital on 7 February 2017 and the remarks by the director general of the HSE on 7 February 2017 that there is not enough money at present to ensure the project is carried through to fruition; if there is no additional funding available, the suggestions his Department has made as to the areas in which cuts and savings could be made to cover the cost of the national children's hospital; and if he will make a statement on the matter. [10851/17]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

Following decades of discussion and debate, Ireland is about to get the new children’s hospital that it badly needs and deserves. An internationally recognised design team, supported by an experienced National Paediatric Hospital Development Board and Project Team is in place to drive the project to develop the new children’s hospital. The tender process for the core construction elements for the new children’s hospital and the satellite centres was highly competitive and a company has been notified that it is the preferred bidder.

A cost estimate was completed in early 2014 when construction inflation was estimated at 3%. The pricing proposed by the tenderers took account of construction inflation (now running at higher than 9%), the extended project timeline, now scheduled to complete in 2021 and the final market cost of the build.

There has been much speculation about the cost of building this hospital. While I am not in a position to comment on contract prices and funding implications at this stage, it is not accurate to compare the €650 million of Exchequer funding approved in 2014 for the core construction of the new children's hospital and two satellite centres with the full programme costs set out in the Final Project Brief.

The costs set out in the Final Project Brief provide for the construction of the core hospital and satellite centres, including VAT provision, risk provision, all fees, decant, external works, enabling costs and project management costs. Importantly, it also includes commercial spaces (underground carpark and retail space), higher education facilities, the Children’s Research and Innovation Centre, and equipment.

The updated capital costs have now been incorporated into the Final Project Brief which has been submitted to my Department by the HSE and is currently under consideration. As identified by my colleague the Minister for Expenditure and Reform and by the HSE, the new children’s hospital is a priority Government project. I intend to bring a Memorandum to Government in the coming weeks on the new children’s hospital. Full details of the costs and funding will be set out in the Memorandum for Government and will form the basis upon which the approval decision will be made. The costs and funding will span the period up to and including 2021, in line with project requirements.

Medicinal Products Reimbursement

Ceisteanna (27)

Marc MacSharry

Ceist:

27. Deputy Marc MacSharry asked the Minister for Health the status of the Orkambi negotiations. [12114/17]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

The HSE has statutory responsibility for decisions on pricing and reimbursement of medicines, in accordance with the Health (Pricing and Supply of Medical Goods) Act 2013.

With regard to Orkambi for the treatment of cystic fibrosis patients aged 12 and older, an application to the HSE from the manufacturer was received in March 2016. The application was considered and not recommended for reimbursement at the submitted price by both the National Centre for Pharmacoeconomics – the NCPE – and the HSE’s Drugs Committee. In December, the HSE Directorate took the decision not to reimburse at the submitted price. The HSE called on the company to re-enter negotiations, with a view to significantly reducing the cost of the treatment.

Further meetings were held with the manufacturer in December and early January. The discussions with the company have broadened to include Orkambi, Kalydeco and further treatments for CF patients. The matter is currently under consideration by the HSE Directorate and by officials in my Department.

I expect that this process will conclude in a period of weeks. However, given the scale of the investment, the potential benefits for Irish patients and the impact of this decision on the health service overall, I believe it is appropriate to allow this statutory process to be concluded so as to bring certainty to matters.

I am acutely aware that the last number of months have been a stressful and worrying time for CF patients and their families. However, the Government’s priority is to achieve the best outcome for Irish patients and the health system overall.

Hospital Appointments Delays

Ceisteanna (28)

Billy Kelleher

Ceist:

28. Deputy Billy Kelleher asked the Minister for Health the action being taken to reduce waiting times for orthodontic treatment; and if he will make a statement on the matter. [12077/17]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

The Programme for a Partnership Government contains a commitment to providing timely access to orthodontic care. In order to address the waiting times being experienced by people who have been referred for orthodontic assessment or treatment, the HSE has commenced an initiative which involves the procurement of orthodontic services in primary care from a number of private service providers. Priority is being accorded to cases of a routine orthodontic nature who have been waiting longest to be seen. Up to the end of February 2017, 2,350 patients have been contacted and 1,431 have accepted transfer from HSE to a private orthodontic provider. Complex cases are not part of the HSE waiting list initiative and will be treated by the HSE orthodontic service.

The HSE is also working to adapt skill-mix to assist in providing more timely access for patients. This involves using orthodontic therapists working under the supervision of specialist orthodontists. Two orthodontic therapists are in place, with a further two are in training and the HSE plan to extend this initiative.

The national approach to future oral health service provision, including orthodontics, will be informed by the National Oral Health Policy which is currently being developed by my Department. The target-date for completion of this policy is late 2017.

Medicinal Products Reimbursement

Ceisteanna (29)

James Lawless

Ceist:

29. Deputy James Lawless asked the Minister for Health the number of applications for the addition of a new medicine to the reimbursement list that are being processed as of 1 March 2017; the number of applications in process on the same date in 2015 and 2016; and if he will make a statement on the matter. [12130/17]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

The HSE has informed me that there were 40 applications for the addition of new chemical entities ongoing as at 1 March 2017. A new chemical entity is a medicine that is not classified as a new generic, new biosimilar or new parallel imported or parallel distributed medicine.

The HSE reports the number of new applications on an annual basis. The HSE has stated that, in 2015 and 2016, there were 63 and 82 applications respectively for new chemical entities. The HSE further advises that 20 to 50 applications would be expected to be ongoing at all times for new medicines and new indications for existing medicines.

Hospitals Funding

Ceisteanna (30)

Eoin Ó Broin

Ceist:

30. Deputy Eoin Ó Broin asked the Minister for Health the additional public funding that would be required to replace private income in public hospitals at current levels; the details of private incomes in public hospitals and hospital groups in each of the past five years; and if he will make a statement on the matter. [11895/17]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

Private patient income in public hospitals was €626m in 2016. This is exclusive of private patient consultant fees which are remitted directly to the treating consultant.

Over €2.7 billion income from private patient fees has been generated in public hospitals over the last 5 years. A detailed breakdown of this income by Hospital Group and individual hospital for each of the last 5 years is being provided directly to the Deputy.

At the simplest level, an additional €626m in public funding would be required to replace private income in public hospitals. However, there are also a range of potential indirect costs which it is not possible to quantify. For example, certain categories of hospital consultant enjoy rights to treat private patients in public hospitals and to receive fees directly for doing so. Elimination of private practice in public hospitals might have implications for the attractiveness of consultant appointments in public hospitals, and the salary levels required to successfully attract consultants generally or in particular specialties.

Ambulance Service

Ceisteanna (31)

Pat Buckley

Ceist:

31. Deputy Pat Buckley asked the Minister for Health his views on the ongoing issues with the ambulance service in Midleton, County Cork; and if he will make a statement on the matter. [12038/17]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

The National Ambulance Service (NAS) is committed to providing a quality ambulance service to the Midleton area. Work is underway to relocate the Midleton station to a more suitable location in Midleton with direct access to the road infrastructure transport arteries. This move is scheduled for the second quarter of this year. I am advised that the current station will remain in operation until the new station opens.

The Deputy may wish to note that, services to the Midleton area are not exclusively provided by staff based at the Midleton station. NAS is moving to a policy of dynamic deployment, where vehicles are strategically located where they are most likely to be required, rather than located at a particular station. Under this policy of dynamic deployment, Midleton is supported by other NAS ambulance bases in East Cork, Cork City, West Waterford and South Tipperary, and resources are dispatched using the Advanced Medical Priority Dispatch System (AMPDS). The AMPDS uses international standards and protocols to determine the priority level of each emergency call which ensures life threatening situations receive an immediate and appropriate response.

Mental Health Services Staff

Ceisteanna (32)

Pat Casey

Ceist:

32. Deputy Pat Casey asked the Minister for Health the targets in place for the recruitment of CAMHS personnel in CHO 7 during 2017. [12109/17]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

The Child and Adolescent Mental Health Services/CAMHS is a specialist mental health service for children and young people. Referrals are accepted for those under the age of 18 where the severity and complexity of the presenting mental health disorder is such that treatment at primary care service level is unlikely to be unsuccessful. The service provides assessment and treatment through a multi-disciplinary team for young people and their families who are experiencing mental health difficulties.

Community Healthcare Organisation 7 provides Child and Adolescent Mental Health Services to the majority of the population under the age of 18 within its boundaries. Other services are provided in a portion of the area, through the Lucena Services, which are managed through CHO 6.

The CHO7 Child and Adolescent Mental Health Service currently operate 8 Community Teams, with a clinical staffing compliment of 76.7 whole time equivalent posts, including a Community Team currently being developed for the Kildare area, in line with new population growth locally. There are currently 8 vacancies on these teams and recruitment is underway to fill these posts.

In addition, the CAMHS service for the wider region will be enhanced by 13 extra whole time clinical staff members in 2017, across a range of disciplines including Psychiatry, Psychology, Nursing, Occupational Therapy, Dietetics and Social Work. This includes approval for CHO7 to develop a multi-disciplinary CAMHS Eating Disorder Service. This Team will consist of a Senior Clinical Psychologist, Senior Social Worker, Senior Occupational Therapist, Senior Dietician, Clinical Nurse Manager, Clinical Nurse Specialist and a Staff Nurse. Recruitment of these additional posts is also underway.

CHO7 is also engaged in discussions with the HSE Mental Health Division in relation to initiating new developments across mental health services in 2017, including CAMHS. I, and my Department officials, will continue to closely monitor mental health developments across all CHO areas over the remainder of this year.

Suicide Prevention

Ceisteanna (33)

Maureen O'Sullivan

Ceist:

33. Deputy Maureen O'Sullivan asked the Minister for Health his plans, in conjunction with the Minister for Education and Skills, to implement a multi-pronged strategy to address the level of youth suicide here. [6761/17]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

In 2015, the Government launched Connecting for Life, Ireland's National Strategy to Reduce Suicide with the aim of reducing suicide and self-harm over 2015-2020. The Strategy sets out a vision where fewer lives are lost through suicide, and where communities and individuals are empowered to improve their mental health and well-being. It provides community-based organisations with guidelines, protocols and training on effective suicide prevention.

One of the main goals in Connecting for Life is to target approaches to reduce suicidal behaviour and improve mental health among priority groups, including young people. Several key actions have been identified to further this goal in the Education sector, including supporting the implementation of the relevant guidelines for mental health promotion and suicide prevention across primary and post-primary schools; supporting Student Support Teams; working with the HSE to develop national guidance for higher education institutions in relation to suicide risk and critical incident response; implementing the National Anti-bullying Action Plan; supporting all junior and senior schools to implement a new Wellbeing programme; and delivering early intervention and psychological support service for young people at primary care level. These actions are part of the overall policy objectives of the Department of Education and Skills. They are supported by my Department and the HSE through the inter-agency implementation arrangements provided for in Connecting for Life and overseen by the Cabinet Committee on Social Policy and Public Service Reform.

Education is recognised as key to improving the mental health, resilience and emotional well-being of our young people. Last year saw the launch of the first Action Plan for Education by the Department of Education and Skills. This included a section on Mental Health and Well-being. The aims in this section were to roll out a national programme to support the implementation of Well-being Guidelines to all primary and post-primary schools; to implement Well-being at Junior Cycle; and to publish the 2015 Lifeskills survey, providing information on how schools cater for the well-being of their students. This plan outlines hundreds of actions and sub-actions to be implemented across 2016-2019, with timelines and lead responsibility assigned. I will be working closely with my colleague the Minister for Education and Skills on this issue to ensure these actions are implemented.

In 2013, the Department of Education and Skills, the HSE, and the Department of Health jointly developed the Well-Being in Post Primary Schools Guidelines for Mental Health Promotion and Suicide Prevention. This was followed in 2015 by the publication of Guidelines setting out a framework for mental health promotion in primary schools. The Department of Health and the Department of Education and Skills continue to work in partnership to support youth mental health.

Hospital Waiting Lists

Ceisteanna (34)

Barry Cowen

Ceist:

34. Deputy Barry Cowen asked the Minister for Health the targets in place for reducing outpatient waiting times in the Midland Regional Hospital, Tullamore, in 2017. [12126/17]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

This Government is committed to reducing waiting times for patients, both for patients waiting for inpatient or daycase procedures and for outpatient appointments. During 2016, there has been evidence of a considerable increase in demand for health services, as our population grows and ages. In order to reduce the numbers of long-waiting patients, the HSE is currently developing Waiting List Action Plans for 2017 in the area of Inpatient Daycase, Scoliosis and Outpatient Services. Draft Waiting List Action Plans for Inpatient Daycase and Scoliosis have been submitted. My Department is currently reviewing these plans and engagement is ongoing with the HSE and the NTPF.

In addition, in November, the HSE launched the Strategy for the Design of Integrated Outpatient Services 2016-2020. This strategy seeks to improve waiting times for outpatient services in the long term by restructuring referral pathways and utilising technology to improve service delivery. The HSE has also significantly progressed the development of a draft Outpatient Waiting List Action Plan. In this Plan, the HSE will identify proposals to reduce the number of patients waiting long periods of time for outpatient appointments across all hospitals including the Midlands Regional Hospital, Tullamore.

I expect to make known the details of the HSE's Outpatient Waiting List Action Plan in the coming weeks.

HSE Staff Remuneration

Ceisteanna (35)

Peter Burke

Ceist:

35. Deputy Peter Burke asked the Minister for Health if he will provide an update on intern health care assistants pay discrepancies in the Midland Regional Hospital, Mullingar, and nationally which was the subject of negotiation with trade unions; and if he will make a statement on the matter. [11901/17]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

The Public Service Agreement 2013 to 2016 provided for the introduction of an Intern Scheme for Health Support Staff during the moratorium on recruitment and promotion within the public service as an exceptional recruitment measure. Under the terms of this Scheme, Interns were given a 2 year contract with a starting salary of 85% of the first point of the salary scale in year 1, progressing to 90% of same in year 2.

Later discussions during the Lansdowne Road Agreement provided that where Interns had completed 18 months of satisfactory service, they would be regularised into permanent positions. HSE HR Circular 025/2015 on the Intern Scheme advised Hospital Groups that support grades should not be recruited to positions in services where there are existing Interns in situ unless those positions have been made available to those interns in the first instance.

Separately and outside of the Public Service Agreement process, the National Recruitment Service for the HSE, after the ending of the moratorium on recruitment, resumed the process of filling a number of vacancies on a permanent basis from panels that had been in place for some time. Given the time frames involved in completing the Intern scheme, a situation has arisen where interns who have not yet completed their 18 months satisfactory service are working alongside new recruits to these support grades.

It is accepted by all parties that this situation has given rise to some unintended anomalies. It is expected that these anomalies will be addressed as part of the discussions in the next round of pay talks expected to commence later this year.

Medicinal Products

Ceisteanna (36)

Michael Moynihan

Ceist:

36. Deputy Michael Moynihan asked the Minister for Health his plans to provide for medicinal use of cannabis. [12122/17]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

On 3 November 2016 I asked the Health Products Regulatory Authority to examine the issue of medicinal cannabis and provide me with a report on the matter. I received the Authority's report ‘Cannabis for Medical Use – A Scientific Review’ on 31 January last.

On 10 February, I published the report and announced the establishment of an access programme for cannabis-based treatments for the following conditions;

- Spasticity associated with multiple sclerosis resistant to all standard therapies and interventions;

- Intractable nausea and vomiting associated with chemotherapy, despite the use of standard anti-emetic regimes;

- Severe, refractory (treatment-resistant) epilepsy that has failed to respond to standard anticonvulsant medications.

Patients accessing cannabis through the programme are required to be under the care of a medical consultant.

The report has been referred to the Joint Oireachtas Committee on Health for consideration. Meanwhile officials from my Department and the Health Products Regulatory Authority will consult with stakeholders on how the access programme will operate. It will be particularly important to engage with the clinical community in the development of a framework. Officials are also examining legislative changes that will be required to underpin the access programme.

I intend to progress the establishment of this access programme as a priority. However, to be clear, patients accessing cannabis through the cannabis access programme will need to be recommended for cannabis treatment by a relevant clinician involved in the patient's care. This recognises the relevance of such treatment for overall case planning and management of the underlying medical condition.

For the period during which this access programme is being established, it remains open to me as the Minister for Health to grant a licence under the Misuse of Drugs Act for access to cannabis for medical purposes in individual cases. Such applications will be considered on a case by case basis. The granting of a licence must, however, be premised on an appropriate application being submitted to the Department of Health, which is endorsed by a consultant who is responsible for the management of the patient and who is prepared to monitor the effects of the treatment over time.

The doctor-patient relationship is a fundamental principle upon which medical practice is based and decisions by me as the Minister for Health must respect the primacy and independence of this relationship in delivering patient care.

Hospital Staff

Ceisteanna (37)

Jack Chambers

Ceist:

37. Deputy Jack Chambers asked the Minister for Health his plans to increase nursing levels in hospitals; the measures in place to attract Irish nurses who are working abroad; and if he will make a statement on the matter. [12056/17]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

During recent engagement between this Department, the Department of Public Expenditure and Reform, the HSE, INMO and SIPTU to avert the proposed industrial action by the INMO scheduled for the 7th March, the management side supplied a joint proposal document setting out a number of specific measures to attract and retain nursing staff. This was done in the context of HSE management having developed a fully funded workforce plan for an additional 1,208 nursing/midwifery posts in 2017. The proposal includes extensive education and personal development opportunities for nurses and midwives to upskill, and a pilot pre-retirement initiative as a method of retaining the expertise of experienced nursing/midwifery staff. It also includes 127 promotional posts for staff nurses/midwives to Clinical Nurse/Midwife Manager 1 to provide attractive career pathways for retention purposes and provide direct support to all nursing staff, including newly recruited staff. The management side is also positively disposed to a proposal from the union side for the restoration of a number of allowances for new entrant nurses and this consideration will be concluded in the upcoming pay talks in the summer.

The above is in addition to the many other 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 has offered permanent posts to 2016 degree programme graduates in order to retain its graduates. The HSE is also offering full time permanent contracts to those in temporary posts and is also focused on converting posts filled by agency staffing to permanent posts. Its National Recruitment Service is actively operating rolling nursing recruitment campaigns. 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 interested in working in the Irish Public Health Service. A further event is scheduled for 31 March 2017. A relocation package of up to €1,500 continues to be available to nurses who return from overseas.

Medicinal Products Reimbursement

Ceisteanna (38)

Ruth Coppinger

Ceist:

38. Deputy Ruth Coppinger asked the Minister for Health if he will address the case of a person (details supplied) with a pharmaceutical company; his views on the national plan for rare diseases; and if he will make a statement on the matter. [12076/17]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

The HSE has statutory responsibility for decisions on pricing and reimbursement of medicines in the community drugs schemes, in accordance with the Health (Pricing and Supply of Medical Goods) Act 2013. As Minister for Health I have no function in this statutory process.

I am informed that the manufacturer has submitted an application to the HSE for reimbursement of Procysbi. As far back as December 2015, the manufacturer was asked to submit a health technology assessment dossier to assist in decision-making. That dossier is awaited.

The NCPE recommendation in relation to the need for a full health technology assessment is published online on the NCPE website. The NCPE reviewed the medicine again in January 2017, following, some revisions by the manufacturer, and recommended that an HTA dossier would still be required to assist decision-making. The HSE informed the manufacturer of this ongoing requirement again on 31 January 2017.

I have asked the HSE to reply directly to the Deputy in relation to the individual case raised.

The National Rare Disease Plan provides a policy framework for the diagnosis and treatment of people with rare diseases, of which there are between 5000 and 8000 Ireland. The plan made 48 recommendations designed to help improve the lives of people affected by rare disease. An Oversight Group – chaired by the Department – is overseeing progress with the plan.

An Interim Report on the implementation of the National Rare Disease Plan for Ireland was published last Tuesday, 28th February. Implementation of the plan is well underway and we are already into the second half of the implementation period.

In 2016 a number of projects were funded by the State with €1.686m, matched by charity funding of €1.224m. The total funding of €2.91m is shared between 11 charities. The next round of this joint funding initiative will open in autumn 2017.

The EU commission now intends to explore the possibility to further strengthen the collaboration between Member States and the Commission in the area of research on rare diseases. In addition, rare diseases have already been tabled on the agenda for North-South meetings. Therefore, future work to deepen cooperation between both jurisdictions on rare diseases is anticipated.

Disease Management

Ceisteanna (39)

John McGuinness

Ceist:

39. Deputy John McGuinness asked the Minister for Health the supports in place for persons with Lyme disease. [12083/17]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

Lyme disease (also known as Lyme borreliosis or LB) is an infection caused by a spiral-shaped bacterium called Borrelia burgdorferi that is transmitted to humans by bites from ticks infected with the bacteria. The infection is generally mild affecting only the skin, but can occasionally be more severe. Lyme disease is the commonest cause of tick-borne infection in Europe.

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 in 2006.

A Lyme Borreliosis Sub-Committee of the Scientific Advisory Committee of the Health Protection Surveillance Centre has been established to look at methods of raising awareness especially in those areas (including recreation areas) where Lyme carrying ticks can be most expected to be found. The aim of this Sub-Committee is to develop strategies to undertake primary prevention in order to minimise the harm caused by Lyme Borreliosis in Ireland. 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, an Environmental Health Officer, and a member of Tick Talk who has been invited to be the patient representative on the Sub-Committee. The initial work stream 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.

Health Services Provision

Ceisteanna (40)

John Brady

Ceist:

40. Deputy John Brady asked the Minister for Health if provision has been made within the HSE action plan for scoliosis for the reintroduction of checks in primary schools by public health nurses for the identification of scoliosis; and if he will make a statement on the matter. [11816/17]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

A draft Waiting List Action Plan for Scoliosis has been submitted by the HSE to my Department. The draft action plan for Scoliosis includes both measures to increase capacity for scoliosis treatments in the children's hospitals and proposals for the outsourcing of procedures. Officials are currently reviewing and evaluating the plan and engagement is ongoing with the HSE and the NTPF towards its finalisation. I expect to make known the details of the HSE's Waiting List Action Plan including the Action Plan for Scoliosis in the coming weeks.

In relation to the Deputy's query on screening in primary schools, I have recently been in contact with the Director General of the HSE on this matter and have asked my Department to review policy in this area and provide me with advice.

Services for People with Disabilities

Ceisteanna (41)

Joan Collins

Ceist:

41. Deputy Joan Collins asked the Minister for Health his views on the lack of services for children with complex and non-complex intellectual and physical disability needs in St. John of God special needs school in Islandbridge, Dublin 8 (details supplied). [12062/17]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

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.

Respite Care Services Provision

Ceisteanna (42)

John Brassil

Ceist:

42. Deputy John Brassil asked the Minister for Health the funding in place for the proposed respite care facility at Kilmorna, Listowel, County Kerry; and if he will make a statement on the matter. [12092/17]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

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.

The Programme for Partnership Government states that the Government wishes to provide more accessible respite care to facilitate full support for people with a disability.

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 Provision

Ceisteanna (43)

John Brassil

Ceist:

43. Deputy John Brassil asked the Minister for Health when the Deerpark mental health facility in Killarney will open; and if he will make a statement on the matter. [12093/17]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

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

Hospital Services

Ceisteanna (44, 49)

Shane Cassells

Ceist:

44. Deputy Shane Cassells asked the Minister for Health his plans in place to enable Our Lady's Hospital, Navan, to carry out more scheduled treatments; and if he will make a statement on the matter. [12096/17]

Amharc ar fhreagra

Shane Cassells

Ceist:

49. Deputy Shane Cassells asked the Minister for Health the status of plans for a regional hospital in Navan. [12097/17]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

I propose to take Questions Nos. 44 and 49 together.

There are currently no plans to construct a regional hospital for the north east in Navan. The proposal that a regional hospital be developed in Navan originated in a report prepared for the HSE in 2008. This proposal was superseded by the Government's decision, in 2013, to re-organise acute hospitals into Hospital Groups.

Our Lady’s Hospital Navan is part of the Ireland East Hospital Group. Every hospital in that Group, large and small, has a vital role to play within the Group, with smaller hospitals managing routine, urgent or planned care locally and more complex care managed in the larger hospitals.

Currently, the Hospital Group is engaged in a programme of re-design work to further integrate and enhance the role of Navan hospital within the Group and to ensure that it will provide more services safely and appropriately. A key development has been efforts to promote better integration between the Mater and Navan hospitals, in relation to day surgical activity in Navan, with surgeons from the Mater carrying out surgery in Navan. Recent capital investments include upgrade of general theatres and the Sterile Services Unit and refurbishment of the Emergency Department.

The Hospital Redesign Working Group includes representation from local GPs, the National Ambulance Service, the Mater and Navan Hospitals and from the Ireland East Hospital Group. It is intended that the Hospital Group will continue to engage closely with all interested parties to ensure that the needs of patients, staff, the local and wider community are addressed.

Hospital Services

Ceisteanna (45)

Aindrias Moynihan

Ceist:

45. Deputy Aindrias Moynihan asked the Minister for Health the status of the proposed improvement works for Macroom Community Hospital and services; and if he will make a statement on the matter. [11829/17]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

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

General Practitioner Services Provision

Ceisteanna (46)

Louise O'Reilly

Ceist:

46. Deputy Louise O'Reilly asked the Minister for Health the number of children that have been refused access to general practitioner registration at their first choice of surgery; if he has been contacted by any general practitioners as a result of problems with under six registrations; and if he will make a statement on the matter. [11890/17]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

The introduction of GP care without fees to children under 6 represents a major step forward in improving access, quality and affordability of health care in Ireland. The under-6s GP service contract, which includes age-based preventive checks focused on health and well-being and a cycle of care for children with asthma, underlines the Government’s commitment to enhancing primary care and keeping people well in their own community. To date, approximately 94% of GMS GPs have entered into agreements with the HSE for the provision of services to children under 6 and almost 364,000 children under 6 have access to GP care without fees through a medical card or GP visit card.

Complaints in relation to registration with a GP are dealt with by the HSE in the first instance. Where a GMS patient experiences difficulty in finding a GP to accept him/her as a patient, the HSE has the power to assign an eligible person to a GP's GMS patient list where the person has been removed from another GP's list or refused entry onto a GP's list, and the person has unsuccessfully applied to at least three GPs in the area, who are contracted to provide services under the GMS.

Hospital Services

Ceisteanna (47)

Brendan Griffin

Ceist:

47. Deputy Brendan Griffin asked the Minister for Health the position regarding the provision of a dedicated obstetrics theatre at UHK; and if he will make a statement on the matter. [12035/17]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

In relation to this particular query, as this is a service matter, I have asked the HSE to respond to you directly.

Hospital Waiting Lists

Question No. 49 answered with Question No. 44.

Ceisteanna (48, 53, 60, 101)

Lisa Chambers

Ceist:

48. Deputy Lisa Chambers asked the Minister for Health the targets in place for reducing outpatient waiting times in Mayo University Hospital in 2017; and if he will make a statement on the matter. [12095/17]

Amharc ar fhreagra

Seán Haughey

Ceist:

53. Deputy Seán Haughey asked the Minister for Health the targets in place for reducing outpatient waiting times in Beaumont Hospital in 2017. [12100/17]

Amharc ar fhreagra

Billy Kelleher

Ceist:

60. Deputy Billy Kelleher asked the Minister for Health if the South/South West Hospital Group has an action plan to reduce the waiting times for outpatients, with almost 11,000 appointments outstanding for more than 18 months at the end of January 2017. [12080/17]

Amharc ar fhreagra

Éamon Ó Cuív

Ceist:

101. Deputy Éamon Ó Cuív asked the Minister for Health the targets in place for reducing outpatient waiting times in University College Hospital, Galway, in 2017. [12117/17]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

I propose to take Questions Nos. 48, 53, 60 and 101 together.

This Government is committed to reducing waiting times for patients, both for patients waiting for inpatient or daycase procedures and for outpatient appointments.

During 2016, there has been evidence of a considerable increase in demand for health services, as our population grows and ages.

In order to reduce the numbers of long-waiting patients, the HSE is currently developing Waiting List Action Plans for 2017 in the area of Inpatient Daycase, Scoliosis and Outpatient Services.

Draft Waiting List Action Plans for Inpatient Daycase and Scoliosis have been submitted. My Department is currently reviewing these plans and engagement is ongoing with the HSE and the NTPF.

In addition, in November, the HSE launched the Strategy for the Design of Integrated Outpatient Services 2016-2020. This strategy seeks to improve waiting times for outpatient services in the long term by restructuring referral pathways and utilising technology to improve service delivery. The HSE has also significantly progressed the development of a draft Outpatient Waiting List Action Plan. In this Plan, the HSE will identify proposals to reduce the number of patients waiting long periods of time for outpatient appointments across all hospitals.

I expect to make known the details of the HSE's Outpatient Waiting List Action Plan in the coming weeks.

Question No. 49 answered with Question No. 44.

Hospital Services

Ceisteanna (50)

Eugene Murphy

Ceist:

50. Deputy Eugene Murphy asked the Minister for Health if he will provide a progress report on the proposed ten bed rehabilitation unit at Roscommon University Hospital. [12128/17]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

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

Hospital Waiting Lists

Ceisteanna (51, 88)

Mary Butler

Ceist:

51. Deputy Mary Butler asked the Minister for Health his plans to address the 6,906 patients on a waiting list in University Hospital Waterford for an ear, nose and throat appointment; if he will purchase capacity under the NTPF to significantly reduce this waiting list, which is one of the highest in the country; and if he will make a statement on the matter. [11793/17]

Amharc ar fhreagra

Mary Butler

Ceist:

88. Deputy Mary Butler asked the Minister for Health his plans to address the 6,376 orthopaedic patients on a waiting list in University Hospital Waterford; if he will purchase capacity under the NTPF to significantly reduce this waiting list which is the highest in the country; and if he will make a statement on the matter. [11792/17]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

I propose to take Questions Nos. 51 and 88 together.

This Government is committed to reducing waiting times for patients, both for patients waiting for inpatient or daycase procedures and for outpatient appointments.

During 2016, there has been evidence of a considerable increase in demand for health services, as our population grows and ages.

In order to reduce the numbers of long-waiting patients, the HSE is currently developing Waiting List Action Plans for 2017 in the area of Inpatient Daycase, Scoliosis and Outpatient Services.

Draft Waiting List Action Plans for Inpatient Daycase and Scoliosis have been submitted. My Department is currently reviewing these plans and engagement is ongoing with the HSE and the NTPF.

In addition, in November, the HSE launched the Strategy for the Design of Integrated Outpatient Services 2016-2020. This strategy seeks to improve waiting times for outpatient services in the long term by restructuring referral pathways and utilising technology to improve service delivery. The HSE has also significantly progressed the development of a draft Outpatient Waiting List Action Plan. In this Plan, the HSE will identify proposals to reduce the number of patients waiting long periods of time for outpatient appointments across all hospitals.

I expect to make known the details of the HSE's Outpatient Waiting List Action Plan in the coming weeks.

Mental Health Services Provision

Question No. 53 answered with Question No. 48.

Ceisteanna (52)

Tony McLoughlin

Ceist:

52. Deputy Tony McLoughlin asked the Minister for Health the status of the development of a new 25 bed mental health unit at Sligo University Hospital; the status of the plans to develop mental health and CAMHS services in the northwest region; and if he will make a statement on the matter. [11826/17]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

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

Question No. 53 answered with Question No. 48.