Wednesday, 21 Jun 2017

Written Answers Nos. 183-204

Services for People with Disabilities

Ceisteanna (183)

Fergus O'Dowd

Ceist:

183. Deputy Fergus O'Dowd asked the Minister for Health if a reply will issue to correspondence from a person (details supplied); and if he will make a statement on the matter. [29129/17]

Freagraí scríofa

Minister of State at the Department of 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.

Infectious Diseases

Ceisteanna (184)

Brendan Griffin

Ceist:

184. Deputy Brendan Griffin asked the Minister for Health his views on a matter (details supplied); and if he will make a statement on the matter. [29133/17]

Freagraí scríofa

Minister for Health

Lyme disease is diagnosed by medical history and physical examination. The infection is confirmed by blood tests which look for antibodies produced by an infected person's body in response to the infection. These normally take several weeks to develop and may not be present in the early stages of the disease. The standard approach to Lyme diagnostics is a two-stage approach and involves using a sensitive enzyme immunoassay (EIA) as an initial, screening step. Screening EIAs can be insufficiently specific, giving false-positive reactions in the presence of other similar bacteria, and certain other viral infections, including glandular fever. In addition, blood samples from patients with autoimmune disorders and other inflammatory conditions can also lead to false-positive results. Samples giving positive or equivocal results in screening tests are further investigated in a second-stage immunoblot (Western blot) tests. Use of immunoblot testing greatly increases specificity. Using this two stage approach will give a great degree of certainty around the diagnosis of Lyme.

All clinical (and other) laboratories in Ireland must undergo continuous quality assurance to ensure that the quality of the diagnostics they provide is maintained at the highest international level for human diagnostics. Some laboratories abroad do not use antibody tests like the EIA (screening ELISA test) and Western Blot and instead will use other types of tests, for example, testing for levels of a specific white blood cell (CD-57) or lymphocyte transformation tests (tests to measure how specific cells in a person's immune system respond when exposed to antigens against Borrelia burgdorferi - the bacterium responsible for Lyme disease). These types of tests are not currently recommended by international groups such as the CDC, Infectious Diseases Society of America (IDSA) or BIA for a number of reasons:

1. There is not enough scientific evidence that they are suitable tests to diagnose Lyme disease;

2.-There is no standard method to perform and interpret these kind of tests; and

3. Positive results in these kinds of tests may be due to other illnesses or conditions and not just Borrelia infection.

The Scientific Advisory Committee of the HPSC, the Infectious Diseases Society of Ireland, the Irish Society of Clinical Microbiologists, the Irish Institute of Clinical Neuroscience and the Irish College of General Practitioners agreed a Consensus Statement on the Clinical Management of Lyme Borreliosis, which endorsed the previously referenced, internationally recognised set of guidelines (those of the IDSA) to Medical Practitioners to ensure a standardised approach to the diagnosis and management of Lyme disease in Ireland.

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, an Environmental Health Officer and, very importantly, a representative from Tick Talk Ireland, the primary Support Group for Lyme disease in Ireland.

The initial work of the Lyme Borreliosis Sub-committee involved 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. Material has been produced which is aimed both at the general public and General Practitioners.

Domiciliary Care Allowance Applications are a matter for the Department of Employment and Social Protection.

Medical Card Applications

Ceisteanna (185)

Bernard Durkan

Ceist:

185. Deputy Bernard J. Durkan asked the Minister for Health if a medical card will be granted in the case of a person (details supplied); and if he will make a statement on the matter. [29134/17]

Freagraí scríofa

Minister for Health

The Health Service Executive has been asked to examine this matter and to reply to the Deputy as soon as possible.

The Health Service Executive operates the General Medical Services scheme, which includes medical cards and GP visit cards, under the Health Act 1970, as amended. It has established a dedicated contact service for members of the Oireachtas specifically for queries relating to medical cards and GP visit cards, which the Deputy may wish to use for an earlier response. Contact information was issued to Oireachtas members.

Public Sector Staff Sick Leave

Ceisteanna (186, 187, 188)

Louise O'Reilly

Ceist:

186. Deputy Louise O'Reilly asked the Minister for Health if his attention has been drawn to the fact that HSE staff on certified sick leave are being forced to attend their doctor on a weekly basis to obtain medical certificates at considerable personal and financial cost to them and often at a time when they are not earning due to ill health; and if he will make a statement on the matter. [29141/17]

Louise O'Reilly

Ceist:

187. Deputy Louise O'Reilly asked the Minister for Health if his attention has been drawn to the reason the social welfare certificate submitted for social welfare benefits during a period of extended sick leave is deemed unacceptable; and if he will make a statement on the matter. [29142/17]

Louise O'Reilly

Ceist:

188. Deputy Louise O'Reilly asked the Minister for Health if his attention has been drawn to the reason in circumstances in which a weekly medical certificate is requested by local management for a HSE employee in the ambulance service this cannot be obtained by visiting the HSE occupational health doctor on a weekly basis instead of paying weekly for doctors appointments in circumstances in which the employee has exhausted their entitlement to sick pay; and if he will make a statement on the matter. [29143/17]

Freagraí scríofa

Minister for Health

I propose to take Questions Nos. 186 to 188, inclusive, together.

I have asked the HSE to respond to the Deputy directly on this matter.

Health Services Data

Ceisteanna (189)

Louise O'Reilly

Ceist:

189. Deputy Louise O'Reilly asked the Minister for Health the expected rates of increase in heart failure in the next decade; the cost of heart failure here each year; the hospital related costs; the direct cost of heart failure management; and if he will make a statement on the matter. [29145/17]

Freagraí scríofa

Minister for Health

As the cost of providing health and social care including the cost of acute hospital services to persons affected by heart failure is a service matter it has been referred to the Health Service Executive for attention and direct reply to the Deputy.

Health Services Data

Ceisteanna (190)

Louise O'Reilly

Ceist:

190. Deputy Louise O'Reilly asked the Minister for Health if data suggests a 2% prevalence of symptomatic heart failure in the population rising to 10% in those persons over 75 years of age with a further 2% having asymptomatic left ventricular systolic dysfunction at risk of progressing to symptomatic failure and over 10,000 new cases are diagnosed annually; the updated figures on prevalence and projections since the original 2010 publication of the cardiovascular strategy; the actions taken on recommendations of the cardiovascular strategy; and if he will make a statement on the matter. [29146/17]

Freagraí scríofa

Minister for Health

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

Obesity Strategy

Ceisteanna (191)

Louise O'Reilly

Ceist:

191. Deputy Louise O'Reilly asked the Minister for Health further to Parliamentary Question No. 189 of 25 May 2013, if he will provide the details of the membership of the national reformulation technical working group to agree targets for reducing fat, sugar and salt which is being established; if his Department will be consulting and engaging with the health organisations when targets are agreed similar to the process that will be engaged upon with industry; and if he will make a statement on the matter. [29147/17]

Freagraí scríofa

Minister of State at the Department of Health

In line with the relevant actions in the National Obesity Policy and Action Plan 2016 - 2025, a Food Reformulation Working Group is being established and membership is being determined. Its focus will be to reduce the sugar, fat and salt content of foods and beverages in line with the EU Food Reformulation Project. I am not in a position to preempt the work of the group in advance of the process to establish it being finalised; but engagement with appropriate health expertise is likely to feature in any future work of the group.

Infectious Diseases

Ceisteanna (192)

Billy Kelleher

Ceist:

192. Deputy Billy Kelleher asked the Minister for Health the name, contact details and the location in which persons can be tested for Lyme disease; and if he will make a statement on the matter. [29160/17]

Freagraí scríofa

Minister for Health

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

Hospitals Expenditure

Ceisteanna (193)

Brendan Ryan

Ceist:

193. Deputy Brendan Ryan asked the Minister for Health the amount spent on formula by each maternity and children’s hospital in each of the years 2013 to 2016 and to date in 2017; and if he will make a statement on the matter. [29161/17]

Freagraí scríofa

Minister for Health

In relation to the query raised by the Deputy, as this is a service issue, I have asked the HSE to respond to you directly.

Maternity Services Provision

Ceisteanna (194, 195, 196)

Brendan Ryan

Ceist:

194. Deputy Brendan Ryan asked the Minister for Health his plans to implement co-sleeping beds in the new national maternity hospital being built on the St. Vincent’s campus; and if he will make a statement on the matter. [29162/17]

Brendan Ryan

Ceist:

195. Deputy Brendan Ryan asked the Minister for Health the guidelines the HSE plans to introduce and promote regarding co-sleeping between the newborn baby and mother; and if he will make a statement on the matter. [29163/17]

Brendan Ryan

Ceist:

196. Deputy Brendan Ryan asked the Minister for Health the HSE's policy regarding co-sleeping of baby and mother in maternity hospitals; and if he will make a statement on the matter. [29164/17]

Freagraí scríofa

Minister for Health

I propose to take Questions Nos. 194 to 196, inclusive, together.

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

Health Promotion

Ceisteanna (197, 198, 199, 200, 201)

Brendan Ryan

Ceist:

197. Deputy Brendan Ryan asked the Minister for Health if the HSE has plans to provide information regarding medicine that is safe for breastfeeding to pharmacies, general practitioners and hospitals; and if he will make a statement on the matter. [29165/17]

Brendan Ryan

Ceist:

198. Deputy Brendan Ryan asked the Minister for Health if the HSE plans on using the information regarding medicine that is safe for breastfeeding by a person (details supplied); and if he will make a statement on the matter. [29166/17]

Brendan Ryan

Ceist:

199. Deputy Brendan Ryan asked the Minister for Health the HSE's plans to launch a public awareness campaign to promote the health benefits of breastfeeding; and if he will make a statement on the matter. [29167/17]

Brendan Ryan

Ceist:

200. Deputy Brendan Ryan asked the Minister for Health his plans for health care facilities and practitioners to have a support database that will recommend local breastfeeding support groups to new mothers; and if he will make a statement on the matter. [29168/17]

Brendan Ryan

Ceist:

201. Deputy Brendan Ryan asked the Minister for Health the HSE's plans to create public spaces for breastfeeding support groups in primary care centres; and if he will make a statement on the matter. [29169/17]

Freagraí scríofa

Minister of State at the Department of Health

I propose to take Questions Nos. 197 to 201, inclusive, together.

Some of the matters raised by the Deputy are largely encompassed in the recent Health Service Executive publication entitled Breastfeeding in a Healthy Ireland: the HSE Breastfeeding Action Plan 2016 - 2021.

This Action Plan sets out the priority areas to be addressed over the next 5 years to improve breastfeeding supports, to enable more mothers in Ireland to breastfeed and to improve health outcomes for mothers and children in Ireland. The Action Plan outlines the actions needed to enhance breastfeeding rates and provide skilled supports to mothers, through our maternity services, hospitals, primary care services and in partnership with voluntary breastfeeding organisations and other stakeholders.

These actions include the implementation of policies at hospital and community level; investment in breastfeeding training and skills development for healthcare staff; and partnership working to promote a culture that accepts and supports breastfeeding. The Action Plan is available at www.breastfeeding.ie/Uploads/breastfeeding-in-a-healthy-ireland.pdf.

I am also pleased to advise the deputy that breastfeeding initiatives are also reflected in the Creating a Better Future Together: National Maternity Strategy 2016-2026. This national strategy emphasised the importance of dedicated staff, such as the HSE National Breastfeeding Coordinator and statutory and voluntary supports, in promoting and supporting breastfeeding in Ireland. It referred to the National Breastfeeding Coordinator that works with a national committee to oversee the implementation of breastfeeding action plans and monitors progress in relation to breastfeeding targets; liaising with local breastfeeding committees, maternity hospitals, community health services and voluntary breastfeeding organisations.

Initiatives referred to in the national strategy included an annual National Breastfeeding Week, the HSE website www.breastfeeding.ie , and an on-line Ask the Expert support service provided by International Board Certied Lactation Consultants. Other initiatives mentioned included breastfeeding support groups, the development of a breastfeeding competencies framework, and a breastfeeding policy for primary care teams and community healthcare settings.

Moreover, the National Maternity Strategy reiterated that along with practical supports that can be provided to mothers, such as supports to continue breastfeeding on return to the workplace, a broader societal change is required in order to promote a more positive culture around breastfeeding. This should support women to feel condent about their choice to breastfeed. The Maternity Strategy emphasised that this includes engaging extended family members and childminders who, perhaps due to not being aware of the importance of breastfeeding, may not be best informed to support a family’s choice to feed their baby expressed breast milk while in their care. It referred to breastfeeding promotion campaigns that should be tailored and targeted to help the wider community, including family members, childminders and employers, to play their role in improving Ireland’s breastfeeding initiation and duration rates.

I want to also assure the deputy that the recently published Dept. of Justice and Equality National Strategy for Women and Girls 2017 - 2020: creating a better society for all, contains two actions on increasing the proportion of mothers who breastfeed.

There are some resources available to healthcare professionals in relation the use of medicinal products by breastfeeding mothers. In the first instance the Summary of Product Characteristics (SmPC) should be consulted whenever a practitioner is considering prescribing a medicine to a breast-feeding mother or where the healthcare professional requires information on the suitability of a medicine for breast feeding.

Under EU legislation, product information associated with a medicine consists of the SmPC and the package leaflet. The SmPC is a legal document approved as part of the marketing authorisation of each medicine and forms the basis of information for healthcare professionals on how to use the medicine. This information is presented according to a predefined structure and includes the situations where the medicine must not be used, defining patient populations who must not take the medicines, and special warnings and precautions on the use of the medicine. This includes qualitative and quantitative information on the benefits and the risks posed by the medicine. Section 4.6 of the SmPC provides available information regarding the use of the drug during pregnancy and recommendations on the use or not of the medicine during pregnancy. Recommendation on the need to stop or continue breastfeeding while on the medicine is also provided.

The information contained within the SmPC is updated throughout the lifecycle of the medicine as new data emerge.

The decision on whether to use a medicine during breastfeeding should be reached following a discussion between a prescriber and their patient about the potential risks and benefits of that medicine. In accordance with the Medical Council’s Guide to Professional Conduct and Ethics, medical practitioners must ensure as far as possible that any treatment, medication or therapy prescribed for a patient is safe, evidence-based and in the patient’s best interests.

Patients with queries about the suitability of using a medicine during breast feeding are encouraged to speak to their pharmacist or general practitioner.

Finally, as the questions from the deputy relate mainly to service issues, I have arranged for them to be referred to the Health Service Executive for direct reply on some of the specifics referred to by the Deputy.

The referred replies under Standing Order 42A were forwarded to the Deputy.

Maternity Services Provision

Ceisteanna (202, 203, 204)

Brendan Ryan

Ceist:

202. Deputy Brendan Ryan asked the Minister for Health the hospitals that supply baby boxes for newborn babies; and if he will make a statement on the matter. [29170/17]

Brendan Ryan

Ceist:

203. Deputy Brendan Ryan asked the Minister for Health his plans to provide baby boxes in all maternity hospitals; and if he will make a statement on the matter. [29171/17]

Brendan Ryan

Ceist:

204. Deputy Brendan Ryan asked the Minister for Health the contents of each of the sets of baby boxes; and if the sets provide breastfeeding support items. [29172/17]

Freagraí scríofa

Minister for Health

I propose to take Questions Nos. 202 to 204, inclusive, together.

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