Written Answers Nos. 289-308
289. Deputy Billy Kelleher asked the Minister for Health if the four-month target for persons with scoliosis for 2017 has been discontinued and does not appear in the programme for 2018; and if he will make a statement on the matter. [52800/17]
Amharc ar fhreagra290. Deputy Billy Kelleher asked the Minister for Health if an immediate independent clinical review of scoliosis services will be agreed to in view of the failure to meet scoliosis targets; and if he will make a statement on the matter. [52801/17]
Amharc ar fhreagraI propose to take Questions Nos. 289 and 290 together.
The HSE Action Plan for Scoliosis set out a short to medium term strategy aiming to ensure that no patient requiring surgery for scoliosis would have to wait longer than four months for such surgery by the end of 2017. The action undertaken this year included additional activity within our paediatric hospitals, which was facilitated by the staff recruitment campaigns this year, and outsourcing initiatives to hospitals at home and overseas. For the first time in a number of years, the waiting list for scoliosis-related surgery is reducing.
My Department is committed to supporting the HSE to continue to bring down the waiting times and improve access to scoliosis services, and progress continues on reducing numbers waiting and waiting times in a planned, safe and sustainable manner. The four-month target set by the HSE for long waiters this year has driven the progress that has been made and the Director General of the HSE has indicated that the 4 month target will be maintained for 2018 measured from when the person is determined as needing surgery. A Paediatric Scoliosis Services Co-Design Group is in place, which includes clinicians, hospital staff and representatives from the scoliosis advocacy groups, to design a comprehensive contemporary and patient-centred approach to the delivery of scoliosis services. I had a fruitful meeting with this group recently to discuss their work to date. The work of the Co-Design Group will form the basis for developing scoliosis services into 2018 and beyond. The Group is expected to develop criteria for surgery based on clinical grounds and national and international best practice to ensure that children/young adolescents have surgery when clinically indicated for their individual case and within a time period that does not cause clinical deterioration of their condition, as opposed to within an administrative fixed timeline or target.
Further investment in paediatric orthopaedic services next year is being considered in the context of the 2018 National Service Plan discussions.
291. Deputy Pat Buckley asked the Minister for Health the yearly data on waiting times for when psychiatric patients presented at accident and emergency departments and when they are either admitted for treatment or discharged in each of the years 2010 to 2016 and to date in 2017, by hospital, in tabular form; and if he will make a statement on the matter. [52809/17]
Amharc ar fhreagraAs this is a service matter I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.
292. Deputy Pat Buckley asked the Minister for Health the yearly number of psychiatric patients presented at accident and emergency departments, by hospital, in each of the years 2010 to 2016 and to date in 2017, in tabular form; and if he will make a statement on the matter. [52810/17]
Amharc ar fhreagraAs this is a service matter I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.
293. Deputy Pat Buckley asked the Minister for Health the annual funding provided for the psychiatry and psychology departments, by hospital, in each of the years 2010 to 2016, and to date in 2017, in tabular form; and if he will make a statement on the matter. [52811/17]
Amharc ar fhreagraAs this is a service matter I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.
294. Deputy Pat Buckley asked the Minister for Health the number of persons admitted to psychiatric inpatient beds from the accident and emergency departments; the amount spent annually on these admissions by hospital in each of the years 2006 to 2016, and to date in 2017, in tabular form; and if he will make a statement on the matter. [52812/17]
Amharc ar fhreagraAs this is a service matter I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.
295. Deputy Pat Buckley asked the Minister for Health the cost by quarter of the Little Things mental health campaign. [52813/17]
Amharc ar fhreagra296. Deputy Pat Buckley asked the Minister for Health if the LittleThings mental health campaign is being run by an external company; if so, the nature of the contract, including length of contract, agreed payment, nature of invoicing, details of the person or body that decides campaign messaging and other relevant details; and if he will make a statement on the matter. [52814/17]
Amharc ar fhreagraI propose to take Questions Nos. 295 and 296 together.
As these comprise a service matter I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.
297. Deputy Pat Buckley asked the Minister for Health the number of incidents of self-harm, suicide attempts and suicides that were recorded in each inpatient psychiatric unit in each of the years 2014 to 2016, and to date in 2017, in tabular form; and if he will make a statement on the matter. [52815/17]
Amharc ar fhreagraAs this is a service matter I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.
298. Deputy Pat Buckley asked the Minister for Health the number of return patients for each inpatient psychiatric unit in each of the years 2014 to 2016 and to date in 2017, in tabular form; and if he will make a statement on the matter. [52816/17]
Amharc ar fhreagraAs this is a service matter I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.
299. Deputy Fergus O'Dowd asked the Minister for Health if emergency funding will be made available to fund an outreach team for a project (details supplied) in County Louth to deal with the increase in the area of homelessness and addiction; and if he will make a statement on the matter. [52821/17]
Amharc ar fhreagraWith effect from 1 January 2014, operational and financial responsibility for the Red Door Project was transferred to the HSE. In the circumstances, I have referred this matter to the HSE for direct reply.
300. Deputy Seán Crowe asked the Minister for Health the waiting times for a person to see a gastroenterologist in Tallaght hospital; the number of persons on this waiting list; the longest waiting time on the list; and the measures he is taking in conjunction with the hospital authorities to resolve delays in this area. [52823/17]
Amharc ar fhreagraAs this is a service matter, I have asked the Health Service Executive to respond to you directly.
301. Deputy Billy Kelleher asked the Minister for Health the reason a person (details supplied) has not received files relating to a relative, as promised; when this information will be released; and if he will make a statement on the matter. [52831/17]
Amharc ar fhreagraAs this is a service matter I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.
302. Deputy Darragh O'Brien asked the Minister for Health the number of substance use education and-or prevention workers in each of the regional task force areas; the project promoter for each area, in tabular form; and if he will make a statement on the matter. [52834/17]
Amharc ar fhreagraIt is assumed that the Deputy is referring to staff employed to support the day-to-day operation of Local and Regional Drug and Alcohol Task Forces and HSE Addiction Service staff.
Drug and Alcohol Task Force coordinators are, in the main, employed by the Health Service Executive (HSE). The HSE allocates funding to the 10 Regional Drug and Alcohol Task Forces for various support workers, such as posts of development worker and administrator.
Therefore, I have asked the HSE to collate the information requested and to respond to the Deputy directly.
303. Deputy Kate O'Connell asked the Minister for Health if enzyme replacement therapy is approved by a committee; if so, the reason therefor; the persons who sit on that committee; the frequency with which the committee meets; the approval criteria; and if he will make a statement on the matter. [52835/17]
Amharc ar fhreagra304. Deputy Kate O'Connell asked the Minister for Health if there is a specific budget for enzyme replacement therapy; if so, the way in which it is administered; and if he will make a statement on the matter. [52836/17]
Amharc ar fhreagraI propose to take Questions Nos. 303 and 304 together.
Officials in my Department have sought clarification in relation to these two PQs. Once this information has been received I will arrange for a reply to issue to the Deputy.
305. Deputy Kate O'Connell asked the Minister for Health his views on whether it is appropriate that the HSE does not track the time taken for medicines to be reimbursed against their initial submission date for approval; if he will request the HSE to commence tracking of this data as a key performance indicator in fulfilling its role in assessing and reimbursing new medicines; and if he will make a statement on the matter. [52837/17]
Amharc ar fhreagraThe HSE has statutory responsibility for medicine pricing and reimbursement decisions, in accordance with the Health (Pricing and Supply of Medical Goods) Act 2013. The Act specifies the criteria for decisions on the reimbursement of medicines.
The 2013 Act does not give the Minister for Health any powers in this regard. The HSE does not require approval or consent from the Minister or Government when making a reimbursement decision.
HSE decisions on which medicines are reimbursed by the taxpayer are made on objective, scientific and economic grounds, on the advice of the National Centre for Pharmacoeconomics (NCPE).
The NCPE conducts health technology assessments (HTAs) for the HSE, and makes recommendations on reimbursement to assist HSE decisions. The NCPE uses a decision framework to systematically assess whether a drug is cost-effective as a health intervention.
As outlined in the IPHA agreement, and in line with the 2013 Act, the HSE will decide, within 180 days of receiving the application (or a longer period if further information is sought from the company), to either add the medicine to the reimbursement list or agree to reimburse it as a hospital medicine, or refuse to reimburse the medicine.
The HSE strives to reach a decision in as timely a manner as possible and within the 180 days. However, because of the significant monies involved, it must ensure that the best price is achieved, as these commitments are often multi-million euro investments on an ongoing basis. This can lead to a protracted deliberation process.
The price that some companies are seeking to charge means that the innovative products may never reach the patients as health systems cannot afford the price. In many case the main driver of the price is an estimate of the maximum amount that health care systems can pay and is not connected to the health benefit of the treatment or indeed the development costs.
These high costs cause unnecessary delays in the reimbursement process.
In many cases the price submitted is an artificially high price which will be reduced following rounds of resource intensive negotiations. For example, in 2015 price reductions were negotiated for almost two thirds of medicines that underwent a full health technology assessment.
When the decision is taken not to reimburse a medicine, there is an extension in this timeline. This is due to the requirement of the HSE to issue a “notice of proposal”, and to allow 28 days for manufacturers to make representations to reconsider their decision. The HSE must then consider those representations and it is only after then that they make a formal decision.
306. Deputy Kate O'Connell asked the Minister for Health his views on whether a quality-adjusted life year, QALY, based health technology assessment is an appropriate mechanism for assessing the cost and clinical effectiveness of an orphan medicinal product; if the HSE has found orphan medicinal products to be cost effective under its current health technology assessment; and if he will make a statement on the matter. [52838/17]
Amharc ar fhreagraThe HSE has statutory responsibility for decisions on pricing and reimbursement of medicines under the community drug schemes, in accordance with the provisions of the Health (Pricing and Supply of Medical Goods) Act 2013; therefore, the matter has been referred to the HSE for reply to the Deputy.
307. Deputy Kate O'Connell asked the Minister for Health if an independent expert to review the appropriateness, transparency and timeliness of the HSE's reimbursement process for orphan medicinal drugs will be appointed in view of a growing number of orphan drugs failing to secure reimbursement here despite being made available in other EU countries; and if he will make a statement on the matter. [52839/17]
Amharc ar fhreagraThe Health Service Executive (HSE) has statutory responsibility for decisions on the pricing and reimbursement of medicines, under the Health (Pricing and Supply of Medical Goods) Act 2013. The 2013 Act specifies the criteria to be applied in making decisions on the reimbursement of medicines.
The issue of orphan medicines, with very small patient populations, and the price barriers for health systems in supplying them to patients, is world-wide. Orphan product manufacturers have exclusive patents and are monopoly suppliers. They can, and frequently do, seek very high prices for these products.
The HSE seeks, where possible, to give patients early access to new treatments. However, it must work within the budget provided by the Oireachtas. In the statutory reimbursement process, supported by the 2016 Framework Agreement with industry, the HSE makes decisions on objective scientific and economic grounds. Criteria which must be considered include the population’s health needs, the product’s cost and clinical effectiveness, opportunity costs, the budget impact and available resources.
HSE decisions are supported by health technology assessments (HTAs), which systematically assess whether a drug is a cost-effective health intervention. Currently, most new medicines, including orphan products, undergo HTAs. However, not all applications have sufficient information for assessment and in such cases this must be sought. Also, as HTAs frequently cannot demonstrate value for money for items at the price sought by the company, lengthy price negotiations between the HSE and the manufacturer may be needed. These factors contribute significantly to the length of the reimbursement decision-making process.
A new Committee called the “Rare Diseases Medicinal Products/Technology Review Committee” was established in June 2017 by the National Centre for Pharmacoeconomics. The terms of reference for the Committee have been finalised and the responsibilities of the Committee include the review of proposals for funding new products for rare diseases or expanded indications for existing products for rare diseases. The composition of the Committee will ensure that the voice of patients, patient groups and clinical experts will be available to the HSE when considering reimbursement of drugs for rare diseases.
The Committee will also contribute to the development of clinical guidelines for relevant Orphan Medicinal Products and support the implementation of same.
Dr. Michael Barry was appointed the Chair of the Committee on the 13 September 2017. It is expected that Committee will begin its work in early 2018 after appointment of the necessary support staff.
With the potential costs involved and the competing demands across the health service, every effort must be made to secure the best outcome for the health service and the taxpayer. This includes seeking realistic and sustainable pricing and supply models for new treatments.
308. Deputy Paul Murphy asked the Minister for Health his views on the proposal in the report of the Dublin Midlands Hospitals Group strategy group to downgrade 24-hour accident and emergency cover in Portlaoise hospital; his views on the impact on the local population's health care and the potential complications in the treatment of high-security prisoners in the nearby prison; and if he will make a statement on the matter. [52840/17]
Amharc ar fhreagraThe most important issue in relation to consideration of services at the Midlands Regional Hospital Portlaoise is that patient safety and outcomes must come first. Reports on Portlaoise hospital in recent years have pointed to the need for reconfiguration of some services to ensure that patients are treated in the most appropriate setting by specialist staff that can safely meet their needs. Since 2014, the focus has been on supporting the hospital to develop and enhance management capability, implementing changes required to address clinical service deficiencies, and incorporating the hospital into the governance structures within the Dublin Midlands Hospital Group. Significant work has been undertaken to strengthen and stabilise current arrangements for services at the hospital to ensure that services currently provided that are not sustainable are discontinued and those that are, are safety assured and adequately resourced.
The HSE has confirmed that hospital funding has increased by 28% relative to the 2012 budget and staffing levels have risen by 29% from the 2014 base. Funding of €300,000 has also been provided in 2017 to facilitate the opening of the new medical assessment unit.
In addition, governance and management arrangements in Portlaoise Hospital have been strengthened, additional clinical staff have been appointed and staff training, hospital culture and communications have improved.
The Dublin Midlands Hospital Group has been working for some time on a draft plan for a new model of clinical service delivery at Portlaoise Hospital. A draft plan was submitted to my Department in December 2016. This draft report was reviewed in detail and was the subject of detailed engagement between Department officials and the HSE. Significant additional work was undertaken by the HSE on foot of this engagement resulting in a revised draft plan that was submitted to my Department in September 2017.
The report is currently under detailed consideration in my Department. Once there is an agreed position on the draft plan, it is intended that there will be further engagement with all interested parties, to ensure that the needs of patients, staff, the local and wider community are addressed. Any future changes to services at Portlaoise, will have to take account of existing patient flows and demands in other hospitals, as well as the need to develop particular services at Portlaoise in the context of the overall service configuration in the Dublin Midlands Hospital Group.
