Thursday, 9 Nov 2017

Written Answers Nos. 141-152

National Treatment Purchase Fund Data

Ceisteanna (141, 142, 143)

John Lahart

Ceist:

141. Deputy John Lahart asked the Minister for Health the average cost of individual procedures to date under the National Treatment Purchase Fund, NTPF scheme. [47355/17]

John Lahart

Ceist:

142. Deputy John Lahart asked the Minister for Health the details of the operation of the NTPF; and the way in which a person can avail of the scheme. [47356/17]

John Lahart

Ceist:

143. Deputy John Lahart asked the Minister for Health the procedures carried out under the NTPF scheme to date in 2017. [47357/17]

Freagraí scríofa

Minister for Health

I propose to take Questions Nos. 141 to 143, inclusive, together.

I 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.

Under waiting list initiatives run by the NTPF, the NTPF liaises directly with hospitals to identify patients to be treated. The patients are then contacted to arrange the details of treatment.

My Department has a robust monitoring framework in place which requires the NTPF to submit regular reports to the Department of Health on the number of patients treated, referring hospitals, treating hospitals, and treatment specialty. This monitoring framework also requires reporting on the type, nature and cost of treatments commissioned, including controls to ensure quality patient treatment, value for money and efficient processes.

The recent Budget announced a total 2018 allocation of €55m to the NTPF to address waiting lists and more than doubles their 2017 total allocation. Next year will see a continued focus towards our longest waiting patients, and overall waiting list numbers. It is estimated that this funding has the potential to provide treatment for 18,000 Inpatient/Daycase patients across a range of specialties and procedures through working with both public and private hospitals. This will be in addition to the HSE’s hospital activity funded under Budget 2018. It is not possible to make specific information on costs in relation to individual private hospitals available due to its commercial sensitivity however, the NTPF provides the Department with regular financial reports regarding the waiting list initiatives.

The NTPF advised that, as of 3 November 2017, the following procedures have been undertaken through NTPF funding:

NTPF Insourcing in Public Hospitals:

Procedure

Dental Procedures

Cystoscopies

Angiograms

Cataracts

Carpal Tunnel Release

Hip Replacement

Knee Replacement

Knee Arthroscopy

Inguinal Hernia

Laparoscopic Cholecystectomy

Veins

Gynaecology

Urology

Cruciate Ligament

NTPF Outsourcing to Private Hospitals:

Procedure

Cataracts

Septoplasty

Angiograms

Lesions

Cystoscopy

Veins

DCR (Eye Procedure)

Vasectomy

Entropian

Ectropian

Temporomandibular Joint (TMJ)

Tonsils

Laparoscopic Cholecystectomy

Child Squints

Medicinal Products Data

Ceisteanna (144, 145, 146, 147)

Louise O'Reilly

Ceist:

144. Deputy Louise O'Reilly asked the Minister for Health if a registry of the children affected by foetal anticonvulsant syndrome, also known as foetal valproate syndrome, during pregnancy will be established; and if he will make a statement on the matter. [47360/17]

Louise O'Reilly

Ceist:

145. Deputy Louise O'Reilly asked the Minister for Health if a registry of the women affected by taking sodium valproate during pregnancy will be established; and if he will make a statement on the matter. [47361/17]

Louise O'Reilly

Ceist:

146. Deputy Louise O'Reilly asked the Minister for Health if additional services for children affected by foetal anticonvulsant syndrome during pregnancy will be provided; and if he will make a statement on the matter. [47362/17]

Louise O'Reilly

Ceist:

147. Deputy Louise O'Reilly asked the Minister for Health if a six-monthly screening process for a person exposed to sodium valproate during pregnancy will be provided in order that problems are recognised immediately and supports put in place; and if he will make a statement on the matter. [47363/17]

Freagraí scríofa

Minister for Health

I propose to take Questions Nos. 144 to 147, inclusive, together.

The Irish Epilepsy and Pregnancy Register, based in Beaumont Hospital, was set up in 2001 for pregnant women with epilepsy in Ireland. The aim of this Register is to find out which type of epilepsy drugs women are taking while pregnant and to collect information on the health of their babies after delivery. Since 2007, the Irish Register has had a formal link to the United Kingdom Epilepsy and Pregnancy Register. Women with epilepsy who become pregnant, whether or not they are taking anti-epileptic drugs for their epilepsy, are eligible to register their pregnancy.

In March of this year, the Pharmacovigilance Risk Assessment Committee (PRAC) of the European Medicines Agency (EMA) initiated a new review of the use of valproate-containing medicines in the treatment of women and girls who are pregnant or of childbearing age. This review is examining the available evidence and consulting with relevant stakeholder groups. The most recent component of the current review was a public hearing held at the London offices of the EMA on 26 September.

In its summary of the public hearing, the EMA noted that the PRAC would consider a number of proposals and ideas presented by participants, including registers of women who were receiving valproate and children who had been exposed to valproate during pregnancy.

It is anticipated that the PRAC’s current review of valproate will be concluded before the end of this year. As soon as the review is concluded, the Health Products Regulatory Authority (HPRA), which is the competent authority for the regulation of medicines in Ireland, will communicate the outcome and recommendations of the review to Irish patients, healthcare professionals and relevant stakeholders, including the HSE.

The HSE Clinical Strategy and Programmes Division has developed the National Clinical Programme for Epilepsy, to provide the best value, safe care for all people with epilepsy in the right place, at the right time, sharing the best information available. The model of care under the national clinical programme includes the development of a very detailed Standard Operating Procedure on the management of women with epilepsy. It will cover the pathways of care associated with all aspects of pregnancy, contraception and menopause, and includes detailed support for the obstetrics service in the management of seizures and guidance for ante-natal care, including specific information covering the known extra risks of epilepsy associated with pregnancy to both the mother and foetus.

It is anticipated that this Practice Guide for the Effective Management of Women with Epilepsy will be ready for approval by the HSE before the end of the year.

In relation to the provision of additional services, the overarching principle governing the planning and delivery of health services, and supports for adults and children with disabilities, is that they should be integrated, as much as possible, with services and supports for the rest of the population. The Government’s agenda with regard to disability is set out in the current National Disability Strategy, which is based on a non-condition-specific approach to the delivery of public services. The matter of the services available to these patients has been referred to the HSE for attention and direct reply to you. If you have not received a reply from the HSE within 10 working days, please contact my Private Office and they will follow up with the HSE.

Patients currently taking valproate-containing medicines are advised not to stop taking these medicines and, if they have any concerns about their specific drug treatment and management of their condition, to discuss these with a healthcare professional.

Medicinal Products Regulation

Ceisteanna (148)

Louise O'Reilly

Ceist:

148. Deputy Louise O'Reilly asked the Minister for Health the views of the HSE and his Department when their attention was drawn to the fact that pregnant women were being prescribed sodium valproate without proper provision of information on the side effects; and if he will make a statement on the matter. [47364/17]

Freagraí scríofa

Minister for Health

Valproate medicines have been authorised in all EU Member States for the treatment of epilepsy; whilst valproate-containing medicines are also approved nationally in Ireland to treat bipolar disorder.

Valproate medicines should be initiated and supervised by a specialist experienced in the management of epilepsy or bipolar disorder. It is also recommended that valproate should not be used in women of child-bearing potential unless other treatments are ineffective or not tolerated because of the risk of congenital malformations and developmental disorders in infants exposed to valproate in utero. Women who could become pregnant should be given medical advice on the benefits and risks of treatments before valproate is prescribed and use effective contraception during treatment. Clinicians, in consultation with their patient, may consider the therapeutic benefit of valproate to outweigh any possible risks for individual patients where discontinuation of therapy or switching to alternative therapies is not possible or poses an unacceptable risk to the health of that patient and consequentially to the health of the unborn child.

The Irish Medical Council's Guide to Professional Conduct and Ethics requires registered medical practitioners to make sure that, "any treatment, medication or therapy prescribed for a patient is safe, evidence-based and in the patient's best interests". They should weigh up the potential benefits with the risks of adverse effects and interactions when deciding what to prescribe and should review their patients' treatment regimes periodically. Registered medical practitioners are also required to "keep up-to-date with developments in medication safety."

In 2014 a review of valproate by the European Medicines Agency resulted in measures to strengthen the warnings and restrictions on the use of valproate medicines in women and girls, due to the risk of malformations and developmental problems in babies who are exposed to valproate in the womb. The Health Products Regulatory Authority (HPRA) as the competent authority for the regulation of medicines in Ireland has highlighted the results of previous reviews of valproate and provided revised educational materials for both healthcare professionals and patients. A warning label for the outer packaging of the valproate-containing products was introduced in Ireland earlier this year; products carrying the new external warning label are now being supplied to retail pharmacies.

In 2015 and again in October 2017, the Pharmaceutical Society of Ireland, as regulator for pharmacists and pharmacies in Ireland, again highlighted the risks of the use of valproate in women of child-bearing age to ensure that those patients are informed and understand:

- the risks associated with valproate use during pregnancy;

- the need to use effective contraception;

- the need for regular review of treatment;

- the need to immediately consult a healthcare professional if they are planning a pregnancy or if they become pregnant.

Pharmacists were encouraged to bring these issues, and any other relevant educational materials, to the attention of patients presenting in their pharmacy.

In October 2016, the HSE's Medicines Management Programme (MMP) launched its ‘Valproate Toolkit’, an online resource consisting of a patient information booklet, summary guide for prescribers and a patient/prescriber checklist. This information highlights that sodium valproate should not be prescribed to girls or women of childbearing age or pregnant women unless other treatments are ineffective or not tolerated. The MMP continues to monitor the use of valproate by women of childbearing age.

Hospital Appointments Status

Ceisteanna (149)

Michael Healy-Rae

Ceist:

149. Deputy Michael Healy-Rae asked the Minister for Health the status of a hospital appointment for a person (details supplied); and if he will make a statement on the matter. [47365/17]

Freagraí scríofa

Minister for Health

Under the Health Act 2004, the Health Service Executive (HSE) is required to manage and deliver, or arrange to be delivered on its behalf, health and personal social services. Section 6 of the HSE Governance Act 2013 bars the Minister for Health from directing the HSE to provide a treatment or a personal service to any individual or to confer eligibility on any individual.

The scheduling of appointments for patients is a matter for the hospital to which the patient has been referred. Should a patient's general practitioner consider that the patient's condition warrants an earlier appointment, he or she should take the matter up with the consultant and the hospital involved. In relation to the specific case raised, I have asked the HSE to respond to you directly.

Primary Medical Certificates Applications

Ceisteanna (150)

Michael Healy-Rae

Ceist:

150. Deputy Michael Healy-Rae asked the Minister for Health the status of an application for a primary medical certificate by a person (details supplied); and if he will make a statement on the matter. [47376/17]

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.

As the Deputy's question relates to an individual case, I have arranged for the question to be referred to the Health Service Executive (HSE) for direct reply to the Deputy.

Hospital Appointments Status

Ceisteanna (151)

Éamon Ó Cuív

Ceist:

151. Deputy Éamon Ó Cuív asked the Minister for Health when an operation will be provided for a person (details supplied); the reason for the delay in issuing a date for this procedure; and if he will make a statement on the matter. [47377/17]

Freagraí scríofa

Minister for Health

Under the Health Act 2004, the Health Service Executive (HSE) is required to manage and deliver, or arrange to be delivered on its behalf, health and personal social services. Section 6 of the HSE Governance Act 2013 bars the Minister for Health from directing the HSE to provide a treatment or a personal service to any individual or to confer eligibility on any individual.

The National Waiting List Management Policy, A standardised approach to managing scheduled care treatment for in-patient, day case and planned procedures, January 2014, has been developed to ensure that all administrative, managerial and clinical staff follow an agreed national minimum standard for the management and administration of waiting lists for scheduled care. This policy, which has been adopted by the HSE, sets out the processes that hospitals are to implement to manage waiting lists.

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

Occupational Therapy Provision

Ceisteanna (152)

Robert Troy

Ceist:

152. Deputy Robert Troy asked the Minister for Health if an occupational therapist assessment will be carried out for a person (details supplied); and if he will make a statement on the matter. [47378/17]

Freagraí scríofa

Minister for Health

As this question relates to service matters, I have arranged for the question to be referred to the Health Service Executive (HSE) for direct reply.