Written Answers Nos. 185-205
185. Deputy Sean Fleming asked the Minister for Health his plans to amend the situation in which an immediate family member can have access and discuss the case of a mentally ill relative with their medical advisers in view of the fact that the current confidentiality clause prevents this happening which in some cases may not be ultimately in the interest of the person; and if he will make a statement on the matter. [6491/18]
Amharc ar fhreagraIt is important to recognise that the Medical Council’s Ethical Guide already specifically allows a doctor to ethically breach confidentiality if, for example, he/she believes that the patient is at risk of harming himself/herself or others. Doctors, therefore, have existing powers in exceptional circumstances.
The Expert Group Review of the Mental Health Act 2001, which was published in 2015, recommended that there should be greater ‘proactive encouragement for the patient at all stages to involve his/her family/carer and/or chosen advocate in the admission process and in the development of the care and treatment plan with the patient’s consent ’. The Group did not recommend that family involvement in the care and treatment of patients be made compulsory. There are some serious downsides to consider in terms of taking an absolute approach where those with mental illness may decide not to confide in their Doctor/medical team, if they are strongly against involving family members for whatever reason.
Following on from the Expert Group Review, the Mental Health Commission wrote to all of the Executive Clinical Directors of mental health services reminding them of the importance of involving family members, as appropriate, in accordance with the Commission’s Code of Practice on Admission, Transfer and Discharge to and from an Approved Centre.
In addition, the Commission asked its Health, Social Care and Regulatory Forum to inform each of the professional regulatory bodies represented on the Forum, of the importance of ‘the need to involve families/carers in the development of care and treatment plans with the patient’s consent especially in cases of serious and enduring mental health problems’.
Work is under way at official level on amending the Mental Health Act and I am satisfied that the Expert Group recommendations provide a clear and well thought out direction to amend and update our mental health legislation. While the General Scheme to be prepared will reflect the Group’s view on the need to encourage families to be involved, it will not go so far as to recommend that this be compulsory.
187. Deputy John Brassil asked the Minister for Health the position regarding the reimbursement of Vimizim by the HSE after the recent drugs group meeting on 18 January 2018; and if he will make a statement on the matter. [6496/18]
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.
The Department of Health has been informed that, following an intensive process, the HSE decided not to reimburse Elosulfase alfa (Vimizim). The applicant was notified on 7 November 2017 of the HSE’s decision not to add Vimizim to its reimbursement list. The HSE Drugs Group, which reviewed the effectiveness of the drug, did not consider the evidence for its clinical benefit to be sufficiently strong, in the context of the proposed cost and budget impact.
The HSE advised the company that it would be open to reviewing any additional clinical evidence if same becomes available.
The HSE has confirmed that it has recently received a new application from the manufacturer which is currently under consideration.
Until such time as the process has concluded and a formal decision has been communicated to BioMarin, the application for reimbursement remains under consideration.
188. Deputy John Brassil asked the Minister for Health if he will address the anomaly whereby a homeless person cannot apply for a medical card in view of the fact they do not have a permanent address; the way in which this issue is being dealt with; and if he will make a statement on the matter. [6497/18]
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.
189. Deputy Niamh Smyth asked the Minister for Health the status of a MRI appointment for a person (details supplied); and the position of the person on the waiting list at the dental hospital. [6498/18]
Amharc ar fhreagraUnder 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.
190. Deputy Niamh Smyth asked the Minister for Health his plans to request a machine (details supplied) for Cavan general hospital. [6499/18]
Amharc ar fhreagra191. Deputy Niamh Smyth asked the Minister for Health if the RCSI hospital group has applied for funding for a new emergency department resuscitation area for Cavan general hospital; and if he will make a statement on the matter. [6500/18]
Amharc ar fhreagraI propose to take Questions Nos. 190 and 191 together.
In relation to the specific queries raised by the Deputy, as these are service matters, I have asked the Health Service Executive to respond to you directly.
192. Deputy Niamh Smyth asked the Minister for Health if a hospital appointment for a person (details supplied) will be expedited; the status of same; and if he will make a statement on the matter. [6501/18]
Amharc ar fhreagraThe 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 follows 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 response to the particular query raised, as this is a service matter, I have asked the Health Service Executive to respond to you directly.
193. Deputy Billy Kelleher asked the Minister for Health the measures in place to ensure that persons that are medical card holders are having their medical needs met without charge (details supplied); and if he will make a statement on the matter. [6512/18]
Amharc ar fhreagraWith reference to the provision of public hospital services, including consultant services, x-rays and blood tests, the Health Act 1970 (as amended) provides that all persons ordinarily resident in the country are entitled, subject to certain charges, to public in-patient and out-patient hospital services. The Act also provides that persons with full eligibility, i.e. those with a medical card are eligible for all these services without charge.
Persons with limited eligibility, i.e non-medical card holders are eligible for in-patient and out-patient public hospital services including consultant services, subject to certain charges. The public hospital statutory in-patient charge is €80 in respect of each day during which a person is maintained, up to a maximum payment of €800 in any twelve consecutive months.
Regarding the specific question of the operation of the DePuy ASR Hip reimbursement programme, this is an operational matter for the HSE and, accordingly, I have referred this specific matter to them for direct reply to the Deputy.
194. Deputy Micheál Martin asked the Minister for Health the studies and processes that are ongoing within his Department to remove private patients from public hospitals; the way in which the financial gap will be addressed on implementation of this policy; if it will take ten years to implement same; and if he will make a statement on the matter. [6517/18]
Amharc ar fhreagraI have asked Dr. Donal de Buitléir to chair an Independent Review Group to conduct an impact analysis and review of removing private practice from public hospitals. The Group held its first meeting on 14 December 2017 and is considering issues such as:
- The existing nature, level and role of private practice in public hospitals;
- The negative and positive aspects of private practice in public hospitals, including as regards access to healthcare, equity and the operation of public hospitals;
- What practical approaches might be taken to the removal of private practice from public hospitals, including timeframe and phasing;
- Possible impacts, both direct and indirect, immediate and over time, of removing private practice from public hospitals, including but not limited to impacts on: access; hospital activity (including specialist services); funding; recruitment and retention of personnel; and any legal or legislative issues that might arise.
I have asked the Group to complete its work and report by September 2018.
195. Deputy Micheál Martin asked the Minister for Health his views on e-cigarettes; his plans to place a ban on e-cigarettes; and if he will make a statement on the matter. [6518/18]
Amharc ar fhreagraElectronic cigarettes are regulated by the European Union (Manufacture, Presentation and Sale of Tobacco and Related Products) Regulations 2016. These Regulations transposed the European Tobacco Products Directive and came into effect on 20 May 2016.
The introduction of the workplace smoking ban was based on clear and unequivocal evidence that second hand smoke is harmful to non-smokers. That evidence base does not exist for the aerosol generated from e-cigarettes. However, individual organisations/companies are free to introduce an e-cigarette free policy if they so choose.
My Department will continue to monitor the emerging research on these products, so as to inform decisions around any future additional regulation in this area.
196. Deputy Micheál Martin asked the Minister for Health his views on the lack of beds available to young persons that have anorexia nervosa; the number of persons with anorexia nervosa that had to travel abroad to receive treatment; the number of beds in the bed capacity plan that will cater for anorexia nervosa; when they will be delivered; and if he will make a statement on the matter. [6519/18]
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.
197. Deputy Micheál Martin asked the Minister for Health if he, his officials or advisers have had meetings with the strategic communication unit since it was set up; the issues that were discussed; and if he will make a statement on the matter. [6520/18]
Amharc ar fhreagraI, and officials from my Department, have met with officials from the Strategic Communications Unit to discuss cross-Government, citizen-centred communications.
198. Deputy Seán Crowe asked the Minister for Health the approximate waiting time for the diabetic retinol screening clinic in the eye and ear hospital, Adelaide Road, Dublin 2. [6537/18]
Amharc ar fhreagraIn relation to the particular query raised, as this is a service matter, I have asked the HSE to respond to the Deputy directly.
199. Deputy Frank O'Rourke asked the Minister for Health the full range of supports and services that will be put in place for persons attending a centre (details supplied) in County Kildare once the new primary care centre opens in Kilcock; if those supports and services will be transferred over to the new primary care centre; if existing services will be maintained into the future; if families have been notified in regard to proposed changes in supports and services; and if he will make a statement on the matter. [6538/18]
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.
200. Deputy Jack Chambers asked the Minister for Health if funding provision for intensive home care packages, IHCPs, will be increased; if the funding structure for IHCPs will be amended in order that they are provided on a needs basis and not limited by budgetary restrictions; and if he will make a statement on the matter. [6539/18]
Amharc ar fhreagraThe Government is committed to promoting care in the community so that people can continue to live with confidence, security and dignity in their own homes for as long as possible. To support this, we plan to establish a new statutory scheme for the financing and regulation of home care services. The Department is currently engaged in a detailed process to progress this.
In the meantime, the Department and HSE are continuing efforts to incrementally improve the existing services. As detailed in its National Service Plan, the HSE is streamlining home care services by moving towards a single funded service. This combines the funding for home help and standard home care packages which will operate as a single home support service from 2018 onwards.
Home support services are a particular area of focus in Budget 2018, with an additional €18.25m allocated. The additional resources bring the budget for the direct provision of home support services to €408m delivering over 17m home support hours to about 50,500 people. This compares with the estimated 16.34m hours delivered to 50,000 people last year. In addition, 235 intensive home care packages will provide 360,000 home support hours for people with complex needs.
Despite this significant level of service provision, the demand for Home Care continues to grow. It is important to note that the allocation of funding for home care across the system, though significant, is finite and services must therefore be delivered within the funding available. Home care is monitored on an on-going basis, to ensure that activity is maximised relative to individual clients’ assessed care needs and within the overall available resources for home care and having regard to demand throughout the year.
201. Deputy Brian Stanley asked the Minister for Health the status of treatment for a person (details supplied). [6540/18]
Amharc ar fhreagraAs this is a service matter it has been referred to the HSE for attention and direct reply to the Deputy.
202. Deputy Mary Butler asked the Minister for Health if an appointment for a person (details supplied) at University Hospital Waterford will be expedited; and if he will make a statement on the matter. [6542/18]
Amharc ar fhreagraThe 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 follows 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 response to the particular query raised, as this is a service matter, I have asked the Health Service Executive to respond to you directly.
203. Deputy Seamus Healy asked the Minister for Health the position regarding the approval of a new motorised transport scheme and mobility allowance scheme; and if he will make a statement on the matter. [6549/18]
Amharc ar fhreagraThe Deputy will be familiar with the background to the closure of both the Mobility Allowance and Motorised Transport Grant schemes in February 2013. Since the closure of the Mobility Allowance, the Government has directed that the Health Service Executive should continue to pay an equivalent monthly payment of up to €208.50 per month to the 4,133 people in receipt of the Mobility Allowance, on an interim basis, pending the establishment of a new Transport Support Scheme.
The Government decided that the detailed preparatory work required for a new Transport Support Scheme and associated statutory provisions should be progressed by the Minister for Health. The Programme for a Partnership Government acknowledges the ongoing drafting of primary legislation for a new Transport Support Scheme to assist those with a disability to meet their mobility costs. The Health (Transport Support) Bill is on the list of priority legislation for publication in the Spring/Summer session 2018. I can confirm that work on the policy proposals for the new Scheme is at an advanced stage.
The proposals seek to ensure that:
- There is a firm statutory basis to the Scheme's operation;
- There is transparency and equity in the eligibility criteria attaching to the Scheme;
- Resources are targeted at those with greatest needs; and
- The Scheme is capable of being costed and is affordable on its introduction and on an ongoing basis.
The draft General Scheme and Heads of Bill were circulated to other government Departments and have been the subject of consultation between the Department of Health and the Department of Public Expenditure and Reform. It is hoped to circulate a revised Memo for Government and General Scheme shortly, seeking Government approval to the drafting of the Bill for the new Transport Support Payment.
It is important to note that the Disabled Drivers and Disabled Passengers scheme operated by the Revenue Commissioners, remains in place. This scheme provides VRT and VAT relief, an exemption from road tax and a fuel grant to drivers and passengers with a disability, who qualify under the relevant criteria set out in governing regulations made by the Minister for Finance.
Specifically adapted vehicles driven by disabled persons are also exempt from payment of tolls on national toll roads and toll bridges. Transport Infrastructure Ireland has responsibility for this particular Scheme.
204. Deputy Eugene Murphy asked the Minister for Health if his attention has been drawn to the ongoing information technology problems affecting the recently introduced online medical card application service; the steps being taken to rectify the issue; and if he will make a statement on the matter. [6553/18]
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.
205. Deputy Anne Rabbitte asked the Minister for Health the reason a person (details supplied) who is in receipt of an invalidity pension is not eligible for Versatis patches under the reimbursement support through the special drug request section. [6554/18]
Amharc ar fhreagraMedicines play a vital role in improving the health of Irish patients. Securing access to existing and new and innovative medicines is a key objective of the health service. However, the challenge is to do this in an affordable and sustainable manner. The medicines bill for the community drugs schemes – primarily the GMS, Long Term Illness and Drugs Payment schemes and the High Tech Arrangement – was approximately €1.8 billion in 2017.
To ensure patients receive the highest quality care, resources invested in medicines must be used efficiently and effectively. This requires an integrated approach to secure best value for money for all treatments, greater efficiencies in the supply chain and the use of the most cost-effective treatments.
Lidocaine 5% medicated plaster is licensed for the symptomatic relief of neuropathic pain associated with previous herpes zoster (shingles) infection, known as post-herpetic neuralgia (PHN), in adults. It has been reimbursed in the community drugs schemes since 2010. The projected budget impact on introduction was low due to the specific licensed indication but total expenditure has increased significantly, from €9.4 million in 2012 to over €30 million in 2016, mainly from off-license use for pain not associated with shingles.
An HSE Medicines Management Programme (MMP) review of this product highlighted that the clinical evidence for its use in PHN is limited due to lack of comparative data, and its value is uncertain for all other types of pain. The National Centre for Pharmacoeconomics estimated that, in Ireland, only 5-10% of prescribing of this product has been for the licensed indication of PHN.
Following the MMP review, the HSE introduced a new reimbursement system for the product from 1 September 2017. This process supports its appropriate use, ensuring that PHN patients continue to receive this treatment. The HSE estimates that this protocol will reduce annual expenditure on this product by approximately 90%.
Under the protocol, all patients who were receiving antivirals for shingles were automatically approved for the lidocaine medicated plaster. No action was required by GPs and the patient’s pharmacy was notified of his or her approval status.
However, since 1 December 2017, non-shingles patients no longer receive this item under the community drugs schemes. The HSE has produced information leaflets for patients and advised GPs on treatment alternatives.
In exceptional circumstances, the product may be approved for supply through the community schemes for unlicensed indications. GPs apply for reimbursement for unlicensed indications through the online system. The MMP reviews applications before a decision is made and communicated to the GP.
Full details of the review are available on the HSE website at http://hse.ie/eng/about/Who/clinical/natclinprog/medicinemanagementprogramme/yourmedicines/lidocaine-plaster/lidocaine-medicated-plaster.html.
This decision is a matter for the HSE. However, I fully support the objectives of the HSE Medicines Management Programme.
