Written Answers Nos. 96-118
96. Deputy Gino Kenny asked the Minister for Health his views on whether the diagnosis and treatment of Lyme disease here needs to be improved substantially to improve the lives of the many sufferers here; his further views on the fact that in other jurisdictions there are much more advanced and reliable blood tests which should be introduced here in place of the current unreliable ELISA test; and if he will make a statement on the matter. [27733/17]
Amharc ar fhreagraLyme 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:
I. There is not enough scientific evidence that they are suitable tests to diagnose Lyme disease;
II. There is no standard method to perform and interpret these kind of tests; and
III. Positive results in these kinds of tests may be due to other illnesses or conditions and not just Borrelia infection.
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.
The Scientific Advisory Committee of the Health Protection Surveillance Centre (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. The Sub-Committee first met on 6 May 2015 and it is expected to report in 2017.
97. Deputy Billy Kelleher asked the Minister for Health the reason behind the notable regional differences in the provision of home care packages; and if he will make a statement on the matter. [29068/17]
Amharc ar fhreagraAs this is a service matter it has been referred to the Health Service Executive for direct reply.
98. Deputy David Cullinane asked the Minister for Health his plans to address the capacity issues within the public health sector that are being driven in part by low pay and a lack of a clear career path for nurses within the public health sector; and if he will make a statement on the matter. [26059/17]
Amharc ar fhreagraThere has been a significant improvement in the staffing of the public health services in the past three years as the economic position has improved and additional funding has been made available to support service delivery. From end April 2014 to end April 2017, total numbers employed have increased by over 10,000 whole time equivalents to 111,979.
The number of consultants has increased significantly. At the end of April 2017 there were 2,884 whole time equivalents. This constitutes an increase of 298 since April 2014. The number of NCHDs has also increased significantly, from 4,982 at the end of April 2014 to 6,092 at the end of April 2017, in order to support service delivery and progression of compliance with the provisions of the European Working Time Directive.
Nursing and midwifery numbers at the end of April 2017 stood at 36,549 whole time equivalents, having increased by 625 whole time equivalents in the 12 months from end April 2016 and by 1,870 in the three years from end April 2014. Overall nursing numbers (WTEs) are at the highest level since 2011 with numbers increasing consistently since early in 2014. However, given that numbers fell by 5,000 between 2007 and 2013 and that we face increasing service demands due to a growing and ageing population there is an ongoing need to increase numbers.
Under proposals formulated at the WRC between this Department, DPER, the HSE, the INMO and SIPTU in February and March this year it was agreed that management would increase the nursing and midwifery workforce in 2017, through a broad range of initiatives that provide for 1,208 additional permanent posts. Delivery of these posts is possible through a combination of new development posts, for which additional funding is being provided in the current year, and the local conversion of agency employed staff into direct employees. Key measures include the conversion of agency employed staff into HSE direct employees and offering all graduating nurses and midwives full time contracts. Other important elements include enhanced maternity leave cover; a career break scheme; 130 additional undergraduate places in 2017; and offering nurses and midwives improved educational opportunities and career pathways. Recruitment measures include careers days, HSE attendance at national and international recruitment fairs, and a communication from the National Director for HR to all Nursing and Midwifery Graduates.
A number of specific measures have already been taken in relation to nurses pay. These include additional pay in return for taking on some duties from doctors and an increase in the rate of pay for the student nursing placement to 70% of the first point of the staff nurse pay scale. In the last quarter of 2016 the Government approved restoration of incremental credit for 2011 to 2015 graduate nurses in respect of the 36 week clinical placement undertaken by 4th year student nurses in the context of the 2017 Estimates. All nurses and midwives are now eligible for incremental credit for the 36 week placement.
In addition to the pay restoration that is provided for in the Public Service Agreements, and which commenced on 1st April, the recently concluded Draft Public Service Stability Agreement provides for pay increases from the unwinding of FEMPI legislation. It will see those earning up to €30,000 receiving a 7.25% increase with the remainder receiving 5.75% over the lifetime of the agreement. However, public sector unions will have to ballot their members on acceptance or rejection of this Agreement.
99. Deputy Ruth Coppinger asked the Minister for Health the reason contraception is not available through health insurance; if he has discussed this matter with health insurance companies; and if he will make a statement on the matter. [27898/17]
Amharc ar fhreagraUnder 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. Insurers are free to design and sell private health insurance plans, providing the plans comply with the minimum benefits 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.
100. Deputy Stephen S. Donnelly asked the Minister for Health the level of support the Government is offering in order to relocate the European Medicines Agency to Ireland; and if he will provide the associated cost suggested. [25704/17]
Amharc ar fhreagraThe European Medicines Agency (EMA) plays a vital role in the protection of the health of 500 million EU citizens through the scientific evaluation and safety monitoring of human and veterinary medicines. The EMA is also key to maintaining the competitiveness of the European pharmaceutical industry, which is worth approximately €260 billion annually. As a consequence of the United Kingdom's decision to leave the European Union, the EMA must relocate to another Member State. Approximately 20 Members States are seeking to host the Agency. The Government believes that moving the Agency to Dublin would offer a sustainable solution which will minimise any disruption to its critical operations caused by the relocation. In recent months the Minister of State for Health Promotion and I, with the support of Government colleagues and Irish diplomats across the EU, have engaged in an intensive campaign of meetings and visits to promote Dublin’s candidacy. Subject to the finalisation of formal criteria and of the process to be used to arrive at a decision by Member States, it is anticipated that a formal bid must be submitted to the European Council by 31 July 2017. Government has tasked an interdepartmental/interagency group, led by my Department, with the preparation of Ireland’s bid and this group is working intensively to ensure that a high-quality bid is ready for submission by the deadline. The question of providing particular supports to a relocation of the EMA to Dublin will be considered as part of this process.
101. Deputy Gino Kenny asked the Minister for Health if he will consider the motion recently adopted by an organisation (details supplied) calling for the prescription of cannabis for medicinal use not to be restricted to consultants only but to allow general practitioners to do so also; and if he will make a statement on the matter. [27734/17]
Amharc ar fhreagraAs you know, I published the Health Products Regulatory Authority’s report ‘Cannabis for Medical Use – A Scientific Review’ in February and announced my intention to establish a Cannabis Access Programme for cannabis-based treatments to be provided for qualifying patients. The HPRA report recommended that patients accessing cannabis through the programme should be under the care of a medical consultant.
The Chief Medical Officer’s advice reiterates that it is crucial that the granting of a cannabis licence takes due care and consideration of the potential unintended consequences associated with the prescription of cannabis, a schedule 1 controlled drug, for medical purposes, and that its use is endorsed by a consultant who is familiar with and responsible for the care of the individual for whom the licence application is being made.
It has been reported that there is a legal barrier preventing consultants from prescribing cannabis-based treatments. In fact, there is no such legal barrier. It remains open to me, as Minister for Health, to consider granting a licence under the Misuse of Drugs Acts, where the proposed course of treatment has been endorsed by a consultant.
103. Deputy Barry Cowen asked the Minister for Health the way in which the Midland Regional Hospital, Tullamore, will be supported in reducing the number of outpatients enduring long waiting times in the hospital. [29093/17]
Amharc ar fhreagraI acknowledge that waiting times are often unacceptably long and I am conscious of the burden that this places on patients and their families.
There is no doubt that our public hospital system is challenged in meeting the growing demand for care. Last year alone, there was a 2% increase in inpatient and day-case activity over 2015. 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.
In order to reduce the numbers of long-waiting patients, I asked the HSE to develop Waiting List Action Plans for 2017 in the areas of Inpatient/Daycase, Scoliosis and Outpatient Services. The Inpatient / Daycase and Outpatient Plans which have now been published and are currently being implemented, focus on reducing as much as possible within existing resources the number of patients waiting 15 months or more for inpatient and daycase treatment or outpatient appointment by the end of October. The Scoliosis Action Plan aims to ensure that no patient who requires scoliosis surgery will be waiting more than four months for surgery by the end of 2017.
Under these Plans, since early February, over 14,200 patients have come off the Inpatient/Daycase Waiting List, nearly 49,000 patients have come off the Outpatient Waiting List and approximately 130 scoliosis surgeries have taken place.
In addition, the NTPF has advised that under the ongoing Daycase Waiting List Initiative over 2,000 patients files have been transferred to private hospitals under this Initiative, 483 patients have accepted an offer of treatment in a private hospital and that over 120 patients have received their procedure.
104. Deputy Billy Kelleher asked the Minister for Health the reason the task force for the implementation of the national maternity strategy has met just once in 18 months. [29066/17]
Amharc ar fhreagraIreland's first National Maternity Strategy - Creating A Better Future Together 2016 - 2026 -will be implemented on a phased basis. Implementation will be led by the newly established National Women & Infants Health Programme, which was established in January 2017. The Programme chaired the first meeting of the Strategy Implementation Group in April. It is currently working on the detailed implementation plan with a view to completing it by end June.
€3 million development funding provided for maternity services in 2016 was allocated in line with the Strategy, and included funding for additional staff, including 100 midwives, the development of specialist bereavement teams and for the implementation of the Maternal and Newborn Clinical Management System. Increased funding of €6.8m has been provided for maternity services in 2017 which will allow for the continued implementation of the Strategy.
106. Deputy Bríd Smith asked the Minister for Health the way in which he plans to deal with problems of retaining and recruiting staff in key sectors of the health service in the coming period; and if he will make a statement on the matter. [27900/17]
Amharc ar fhreagraIn line with the Department’s Statement of Strategy, the Department of Health is working with the HSE and other cross sectoral partners to develop a national strategic framework for health workforce planning which aims to support the recruitment and retention of the right mix of health workers across the Irish health service to meet planned and projected service need. During 2016, the Department of Health convened a cross-sectoral Steering Group to begin work on the development of this Framework.
Work on the draft framework is well advanced and a stakeholder consultation process on the draft will commence during June. It is anticipated that the finalised framework, and an associated high-level implementation plan, will be submitted to the Minister for Health in September 2017.
In addition, under proposals formulated at the WRC between this Department, DPER, the HSE, the INMO and SIPTU in February and March this year it was agreed that management would increase the HSE’s National Workforce Plan for nurses and midwives in 2017. Management have committed to continuing to increase the nursing and midwifery workforce in 2017, through a broad range of initiatives that will result in the delivery of 1,208 additional permanent posts; including the conversion of agency employed staff into HSE direct employees, and offering all graduating nurses and midwives full time contracts. Other key measures include maternity leave cover; a career break scheme; 130 additional undergraduate places in 2017; and offering nurses and midwives improved educational opportunities and career pathways. Recruitment measures include careers days, HSE attendance at national and international recruitment fairs, and a communication from the National Director for HR to all Nursing and Midwifery Graduates.
Although not limited to the health sector, the recent draft Public Service Stability Agreement also sets out a process for a more comprehensive examination of underlying difficulties in recruitment and retention in certain sectors and employment streams where difficulties are clearly evident. There will be opportunities for submissions to be made to the Public Service Pay Commission and the exercise is due to be completed by end- 2018. Any proposals will be subject to discussion between the parties.
108. Deputy Louise O'Reilly asked the Minister for Health the additional staff that will be employed to ensure the full functioning of the new primary care centre in Balbriggan. [27662/17]
Amharc ar fhreagraAs this question relates to service matters, I have arranged for the question to be referred to the Health Service Executive (HSE) for direct reply.
109. Deputy Niall Collins asked the Minister for Health the way in which University Hospital Limerick will be supported in reducing the number of outpatients enduring long waiting times in the hospital. [29095/17]
Amharc ar fhreagraAs this is a service matter, I have asked the HSE to respond to you directly.
110. Deputy Margaret Murphy O'Mahony asked the Minister for Health the reason for the persistent increase in long waiting times for persons under 18 years of age needing assessment for occupational therapy; and if he will make a statement on the matter. [29076/17]
Amharc ar fhreagraAs this question relates to service matters, I have arranged for the question to be referred to the Health Service Executive (HSE) for direct reply.
111. Deputy Seán Haughey asked the Minister for Health the way in which the Mater hospital will be supported in reducing the number of outpatients and inpatients enduring long waiting times in the hospital. [29098/17]
Amharc ar fhreagraI acknowledge that waiting times are often unacceptably long and I am conscious of the burden that this places on patients and their families.
There is no doubt that our public hospital system is challenged in meeting the growing demand for care. Last year alone, there was a 2% increase in inpatient and day-case activity over 2015. 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.
In order to reduce the numbers of long-waiting patients, I asked the HSE to develop Waiting List Action Plans for 2017 in the areas of Inpatient/Daycase, Scoliosis and Outpatient Services. The Inpatient / Daycase and Outpatient Plans which have now been published and are currently being implemented, focus on reducing as much as possible within existing resources the number of patients waiting 15 months or more for inpatient and daycase treatment or outpatient appointment by the end of October. The Scoliosis Action Plan aims to ensure that no patient who requires scoliosis surgery will be waiting more than four months for surgery by the end of 2017.
Under these Plans, since early February, over 14,200 patients have come off the Inpatient/Daycase Waiting List, nearly 49,000 patients have come off the Outpatient Waiting List and approximately 130 scoliosis surgeries have taken place.
In addition, the NTPF has advised that under the ongoing Daycase Waiting List Initiative over 2,000 patients files have been transferred to private hospitals under this Initiative, 483 patients have accepted an offer of treatment in a private hospital and that over 120 patients have received their procedure.
112. Deputy Thomas P. Broughan asked the Minister for Health the steps his officials are taking to liaise with hospitals and the National Office for Suicide Prevention on the number of self-harm presentations at emergency departments not admitted to wards; if he is examining the reasons and trends for non-admission; and if he will make a statement on the matter. [27786/17]
Amharc ar fhreagraIn March 2016, the HSE Mental Health Division established the National Clinical Programme for the Assessment and Management of Patients Presenting to Emergency Departments following Self-Harm.
This clinical programme specifically addresses the care and treatment required by people who present to the Emergency Departments of acute hospitals following an episode of self-harm or with prominent suicidal ideation.
The aim of this programme is to develop a standardised and effective process for the assessment and management of individuals of all age ranges, including children, adolescents, adults and older adults, who present with self-harm to an Emergency Department.
Training offered by this programme will ensure that patients and their families have access to clinicians with sufficient expertise to provide high-quality, evidence-based care and treatment. Critical to the success of this clinical programme will be the consolidation and further development of close working relationships between the Emergency Department clinical team, mental health liaison staff and Community Mental Health teams and GP services.
The objectives of this programme are to improve the assessment and management of all individuals who present to an Emeregency Department with self-harm, reduce rates of repeated self-harm; improve access to appropriate interventions at times of personal crisis; ensure rapid and timely linkage to appropriate follow-up care, and optimise the experience of families and carers in trying to support those who present with self-harm.
Following clinical assessment of a person who presents to an Emergency Department following self-harm, a decision with regard to ongoing treatment of the individual is required. This may indicate admission to a general hospital if physical care is required. If significant mental health considerations are clinically identified, referral to mental health services in accordance with the criteria set out in the Mental Health Acts may be appropriate.
Alternatively the individual could be referred to appropriate primary care services and supports. All such clinical decisions are set out in the Discharge and Management Plan – Emergency Care Plan developed with and given to the patient and family/friend (with consent).
113. Deputy Billy Kelleher asked the Minister for Health the reason that in May 2017 some 14,389 outpatient appointments had been outstanding in County Cork hospitals for more than a year, a fivefold increase by comparison to May 2014. [29069/17]
Amharc ar fhreagraI acknowledge that waiting times are often unacceptably long and I am conscious of the burden that this places on patients and their families.
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.
In order to reduce the numbers of long-waiting patients, I asked the HSE to develop Waiting List Action Plans for 2017 in the areas of Inpatient/Daycase and Outpatient Services. These plans have now been finalised and their implementation has commenced. It is expected that the Inpatient / Daycase and Outpatient Plans will considerably reduce the number of patients waiting 15 months or more for inpatient and daycase treatment or for an outpatient appointment by the end of October. Under these Plans, since early February, over 14,200 patients have come off the Inpatient/Daycase Waiting List and nearly 49,000 patients have come off the Outpatient Waiting List.
In addition, last December I granted approval to the NTPF for the first tranche of funding in the region of €5m, for an initiative focused on those waiting longest for Daycase treatment with a view to ensuring that in excess of 2,000 patients waiting more than 18 months for a daycase procedure will have received an offer of an appointment for their procedure by the end of June. The NTPF has advised that to date over 2,500 patients files have been transferred to private hospitals under this initiative, 631 patients have accepted an offer of treatment in a private hospital and that 178 patients have received their procedure. In relation to the specific query concerning waiting times for outpatient appointments in hospitals in Co Cork, I have asked the HSE to reply to you directly.
114. Deputy Ruth Coppinger asked the Minister for Health the details of the governance arrangements of St. Vincent's hospital and the national maternity hospital following its relocation to Elm Park, Dublin in view of the recent announcement by the religious Sisters of Charity to not be directly involved in St. Vincent's hospital; and if he will make a statement on the matter. [27899/17]
Amharc ar fhreagraThe Deputy will be aware that I recently asked for a period of time to reflect on, and address, issues associated with the National Maternity Hospital project. While work is continuing on these issues, I am happy to note the significant developments that have taken place over the period. I have met with the Chair and CEO/Master of both hospitals and reaffirmed my commitment to the project. In addition, there has been extensive engagement between the St Vincent's Healthcare Group and my officials.
On 29 May last, the Sisters of Charity announced their decision to relinquish their ownership and involvement with the St. Vincent's Healthcare Group. This decision, on the part of the Sisters, is an extremely significant development for the healthcare sector. My Department has been briefed on this development. The St. Vincent's Healthcare Group's Constitution will no longer refer to the Sisters of Charity and will be amended to reflect compliance with national and international best practice guidelines on medical ethics and the laws of the Republic of Ireland. I know that despite the specific provisions in the Mulvey agreement, there was a concern on the part of some, about the potential religious influence being brought to bear on the new maternity hospital. The decision of the Sisters of Charity is extremely helpful in dispelling any such concerns.
Discussions are continuing with the St. Vincent's Healthcare Group on the terms of the State's investment in the new hospital and, in particular, arrangements for the protection of this investment. The Mulvey agreement envisaged that further consideration was required in relation to the legal mechanisms necessary to protect the State's considerable investment. My Department is very actively engaged in devising suitable arrangements to ensure that the facilities are legally secured on an on-going basis for the delivery of publicly funded maternity, gynaecology and neonatal services.
I hope to update the Government on the project very shortly.
115. Deputy Mick Wallace asked the Minister for Health further to Parliamentary Question No. 79 of 8 March 2017, the measures he is planning in order to ensure that general practitioners do not incorrectly charge medical card holders for routine phlebotomy services; his plans to introduce sanctions for general practitioners that continue to charge patients incorrectly in this regard; and if he will make a statement on the matter. [27869/17]
Amharc ar fhreagraThere is no provision under the GMS GP contract for persons who hold a medical card or GP visit card to be charged for routine phlebotomy services provided by their GP, or the Practice Nurse on behalf of the GP, which are required to either assist in the diagnosis of illness or the treatment of a condition. The HSE has advised GPs that where a blood test forms part of the investigation or necessary treatment of a patient’s symptoms or conditions, this should be free of charge for patients who hold a medical card or GP visit card. I am aware that in recent times, some GPs have begun to charge GMS patients for phlebotomy services in some circumstances.
This is a matter of concern to me as it has long been the position of Government and the Oireachtas that no user charges should apply to GP services provided to GMS and GP visit card patients. If a patient who holds a medical card or GP visit card believes he or she has been incorrectly charged for routine phlebotomy services by his or her GP, then that patient may make a complaint to the HSE Local Health Office, who will deal with the matter in accordance with the HSE's Complaints Policy.
In order to achieve clarity on this issue, I have asked that any difference of perspective in relation to the provision of phlebotomy services be addressed in the GP contractual review process, which is currently underway. I look forward to constructive and positive engagements with a view to achieving a satisfactory outcome.
116. Deputy Billy Kelleher asked the Minister for Health if waiting time targets for cancer diagnoses are being met; and if he will make a statement on the matter. [29067/17]
Amharc ar fhreagraThe HSE’s National Cancer Control Programme set up Symptomatic Breast Disease clinics and Rapid Access Clinics for Lung and Prostate cancer at eight designated cancer centres over the period 2009-2012. A symptomatic breast cancer service was also set up in Letterkenny University Hospital as a satellite of the Galway University Hospital service.
These clinics provide high quality diagnostic services to patients with symptoms indicating possible breast, lung or prostate cancer. Data on Rapid Access Clinic attendances in all cancer centres are captured monthly, with the April 2017 report being the most recent. Many hospitals services are meeting target time frames. However, issues with respect to achieving targets are being experienced in some cancer centres.
The national target for Symptomatic Breast Disease clinics is that 95% of all urgent referrals are offered an appointment within 10 working days of the date of receipt of a referral letter. In April 74.6% of patients were offered an appointment within this time frame.
With regards to lung cancer Rapid Access Clinics, the national target is also that 95% of all lung cancer patients are offered an appointment within 10 working dates of the date of receipt of the referral letter. In April 85.4% of patients were offered appointments within 10 days.
The national target for prostate cancer Rapid Access Clinics is that 90% of all prostate cancer patients are offered an appointment within 20 working days of the date of the receipt of a referral letter. A total of 43.3% of patients were seen within 20 working days in April.
A review of cancer Rapid Access Clinics and Symptomatic Breast Disease clinics across all cancer centres has been undertaken by the National Cancer Control Programme and has been finalised recently. A set of recommendations for hospitals and Hospital Groups to support sustainable improvement in the performance of clinics was developed and implementation has begun.
Performance of clinics will continue to be closely monitored with a view to ensuring improvement over a period of time so that patients are seen within the target ranges at all centres.
117. Deputy Robert Troy asked the Minister for Health if he will address the drop in home help hours which has recently been reported for counties Longford and Westmeath; and his plans to increase these hours as a matter of urgency. [27842/17]
Amharc ar fhreagraAs this is a service matter it has been referred to the Health Service Executive for direct reply.
118. Deputy Niamh Smyth asked the Minister for Health if he will address the waiting times for children waiting for orthodontic treatment; and if he will make a statement on the matter. [29061/17]
Amharc ar fhreagraAs this is a service matter it has been referred to the HSE for reply to the Deputy.
