Written Answers Nos 62-83
62. Deputy Billy Kelleher asked the Minister for Health his plans in 2018 to address the long-standing need for the provision of a neuro-rehabilitation unit to serve counties Cork and Kerry; and if he will make a statement on the matter. [6394/18]
Amharc ar fhreagraThe 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 service matters, I have arranged for the question to be referred to the Health Service Executive (HSE) for direct reply to the Deputy.
63. Deputy Pat The Cope Gallagher asked the Minister for Health his plans for Stranorlar, Ramelton and Lifford community hospitals in County Donegal; if the decision to remove long-stay accommodation beds from all three hospitals has been fully rescinded; when he plans to allocate the necessary funding to upgrade these three community hospitals in view of the previous false announcements; and if he will make a statement on the matter. [6099/18]
Amharc ar fhreagraThe position remains the same as set out in PQ 1454/18 (Order number 1039) of the 16 January 2018.
66. Deputy Bernard J. Durkan asked the Minister for Health the most effective and immediate action that can be taken to alleviate overcrowding in emergency departments nationally; if an analysis has been carried out with a view to identifying the capacity and demand at all accident and emergency units; and if he will make a statement on the matter. [6364/18]
Amharc ar fhreagra221. Deputy Bernard J. Durkan asked the Minister for Health the degree to which the actual deficit in accommodation at the various accident and emergency hospitals throughout the country as experienced in January 2018 has been identified; if extra accommodation and staffing will be provided to address this issue in the future; and if he will make a statement on the matter. [6615/18]
Amharc ar fhreagra233. Deputy Bernard J. Durkan asked the Minister for Health the extent to which he can provide or avail of step-down bed accommodation in all areas throughout the country as a means of alleviating overcrowding in public hospitals in general; if he has examined the potential use of decommissioned beds or wards in or adjacent to the public hospitals, thereby providing an available solution; and if he will make a statement on the matter. [6627/18]
Amharc ar fhreagraI propose to take Questions Nos. 66, 221 and 233 together.
Tackling overcrowding in Emergency Departments (EDs) is a key commitment of the Government. Accordingly, €30 million in additional funding was provided in 2017, and a further €40 million is being made available in 2018, to manage the expected peak in demand for our health services over the winter period and to strengthen capacity moving forward.
Since the start of this winter, 170 additional beds haven been opened nationally, in St Vincent’s University Hospital, Our Lady of Lourdes Hospital Drogheda, University Hospital Limerick, University Hospital Galway, Beaumont Hospital Dublin, St. James Hospital Dublin, the Mater Hospital Dublin and in Naas General Hospital.
Building further on the learning from the Health Systems Capacity Review, and as part of planning for Winter 2018/2019, my Department is working closely with the HSE to identify where additional bed capacity can be brought on stream as early as possible in 2018, with a view to supporting patient flow within our Acute Hospitals and alleviating the level of overcrowding the system is currently experiencing.
Furthermore I am aware that the HSE is currently developing a three year plan for unscheduled care, which will include a capacity and demand element, and which will feed into the decision making process moving forward.
67. Deputy Kevin O'Keeffe asked the Minister for Health his views on the advertising restrictions imposed by the Pre-Hospital Emergency Care Council, PHECC, which will have a detrimental effect on the livelihoods of first aid instructors and smaller providers; his plans to put in place provisions or assistance to protect these persons; and if his attention has been drawn to the fact that the same instructors are compelled by PHECC policy to enter into contractual agreements with approved providers to carry out their work but are not subject to the same protections by the PHECC with regard to the non-payment of work and other concerns they may have. [6098/18]
Amharc ar fhreagraThe Pre-Hospital Emergency Care Council (PHECC) is the statutory body responsible for standards, education and training in the area of pre-hospital emergency care. PHECC's statutory functions encompass the recognition and assessment of institutions providing education and training in pre-hospital care and the determination of the standards for training courses.
PHECC has a long standing, established model for the provision of Pre Hospital Emergency Care Education and Training at voluntary responder and regulated practitioner levels. Training institutions/individuals who wish to conduct courses and award PHECC qualifications must comply with, and meet, the Council approved PHECC Education and Training standard commensurate with the particular course they wish to conduct and certificate they seek to award. Training organisations, including sole traders, who wish to deliver training and award PHECC qualifications are required, and are encouraged, to become a Recognised Institution (RI) with PHECC.
In view of the need to protect the safety of the public, a strict criteria is in place for the use of the PHECC logo; use of the logo on promotional material or to advertise PHECC approved courses, is only permitted where an individual or an organisation is an approved RI.
I have been assured by PHECC that the RI application process is not unduly onerous. PHECC is committed to improving its services for all stakeholders and, in that regard, I understand that an online portal has been developed for applicants seeking RI status. PHECC anticipates that this online portal, which will significantly aid in the communication and interactions between PHECC and prospective applicants, will be launched in the coming weeks. PHECC will also be providing regional information sessions to its stakeholders, including any persons and organisations seeking to apply for RI status.
68. Deputy Declan Breathnach asked the Minister for Health his plans to provide a full multidisciplinary community neuro-rehabilitation team in County Louth. [6418/18]
Amharc ar fhreagraThe 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 service matters, I have arranged for the question to be referred to the Health Service Executive (HSE) for direct reply to the Deputy.
69. Deputy Gino Kenny asked the Minister for Health the guidelines on the proposed cannabis access programme; when he envisages the programme being fully operational; and if he will make a statement on the matter. [6095/18]
Amharc ar fhreagraOn foot of the 2017 HPRA report ‘Cannabis for Medical Use – A Scientific Review’ I announced the establishment of a cannabis for medical use access programme for patients under the care of a consultant and suffering from certain medical conditions which have failed to respond to all other previous treatments.
The Programme is intended to facilitate access to cannabis-based products that are not authorised as medicines but are of a standardised quality and meet an acceptable level of quality assurance.
An Expert Group, chaired by Dr Mairín Ryan of HIQA, was established to advise on the development of the Programme, and has recently drawn up clinical guidance for healthcare professionals treating patients through the Access Programme.
The guidelines are intended for use by healthcare professionals using cannabis-based products for the treatment of patients under their care, including consultants responsible for the initiation and management of treatment, general practitioners (GPs) responsible for the continuation and monitoring of treatment, nurses responsible for the monitoring of patients, and pharmacists that dispense cannabis-based products and advise patients.
They provide detailed guidance under the headings Aims, Context and Scope, Guidelines for Treatment, Contraindications and Precautions, Ongoing Monitoring etc.
Officials in the Department are working on legislation to underpin the Access Programme. I have requested that a Register, to facilitate the programme, be established and maintained by the HSE. In addition, there are a number of challenges around sourcing and availability of approved products which need to be worked through in a thorough and complete manner.
The work is well advanced but is of a complex nature, and will take some further time to complete.
70. Deputy Frank O'Rourke asked the Minister for Health if there is a targeted investment programme in place for spinal surgery services at Tallaght Hospital to deal with the waiting lists; if provision will be made for an additional surgical operating theatre in view of the fact that at present Tallaght Hospital is renting theatre space from a private hospital to deal with deteriorating waiting lists; and if he will make a statement on the matter. [6104/18]
Amharc ar fhreagraReducing waiting times for patients is one of the Government's key priorities.
Throughout 2017, the HSE and NTPF worked together to drive down long wait times for Inpatient and Daycase procedures. Over 29,000 patients came off the Inpatient/Daycase waiting list by the end of October .
In order to continue the strong focus on reducing waiting times for scheduled care, Budget 2018 included an allocation of additional funding to fund further waiting list initiatives in 2017. This included an initiative to treat complex spinal patients on the Tallaght Hospital waiting list. Provision of treatment under this initiative is ongoing.
October's Budget announced a total 2018 allocation of €55m for the NTPF for 2018. This significant increase in funding more than doubles the 2017 total allocation of €20m. The NTPF and HSE are in the process of finalising Waiting List Action Plans and Initiatives for 2018. This will include ambitious targets for both the HSE and NTPF to reduce the overall number of patients waiting for treatment.
I expect to publish the 2018 Inpatient Day Case Waiting List Action Plan at the end of February.
In relation to the particular query raised regarding surgical theatres, as this is a service matter, I have asked the HSE to respond to the Deputy directly.
71. Deputy Aindrias Moynihan asked the Minister for Health the steps he will take to reduce waiting lists for ophthalmology services at the Mercy University Nospital Cork and the South Infirmary-Victoria Hospital Cork; and if he will make a statement on the matter. [6295/18]
Amharc ar fhreagraI acknowledge that waiting times for Ophthalmology patients are often unacceptably long and I am conscious of the impact of this on people's lives.
Data from the National Treatment Purchase Fund indicates that as of 29 December 2017 there were 23 people waiting for an outpatient Ophthalmology appointment in Mercy University Hospital and 13 people waiting for an Inpatient/Daycase procedure. There was also 1,009 people waiting on an Ophthalmology Inpatient/Daycase procedure in South Infirmary Victoria University Hospital. Of the patients at South Infirmary Victoria University Hospital, approximately 69% (703 people) were waiting less than 6 months for Inpatient/Daycase services and 95% (967 people) were waiting less than 12 months.
Reducing waiting times for the longest waiting patients is one this Government's key priorities. October's Budget announced a total 2018 allocation of €55m for the NTPF for 2018. This significant increase in funding more than doubles the 2017 total allocation of €20m. The NTPF and HSE are in the process of finalising Waiting List Action Plans and Initiatives for 2018. This will include ambitious targets for both the HSE and NTPF to reduce the overall number of patients waiting for treatment, including those patients awaiting Ophthalmology procedures.
I hope to publish the 2018 Inpatient Day Case Waiting List Action Plan at the end of February.
72. Deputy Billy Kelleher asked the Minister for Health the reason it was necessary to write to the Director General of the HSE in January 2018 regarding the executive’s budget for 2018; and if he will make a statement on the matter. [6397/18]
Amharc ar fhreagraI approved the NSP 2018 on its own merits and, as required under legislation, assessed it by reference to relevant legislative provisions, the letter of determination, the policies and objectives of the Government and the HSE’s approved Corporate Plan. It is the responsibility of the HSE to manage the entire budget and to set out in its Service Plan what can be delivered in the coming year within the funding available. My letter in January was responding to the HSE's letter accompanying the NSP, reminding the HSE of its obligation to remain within budget.
It is acknowledged that the issue of health funding is a major policy challenge, not only in Ireland but also internationally, and that the need for effective financial management is crucial. This is particularly the case with an increasing population, an ageing demographic, more acute health and social care requirements and rising demand and cost of both health technology and drugs. It is also important to state that the level of funding provided to the health services in this country compares favourably to health services internationally and health expenditure per capita is above the OECD average.
73. Deputy Peter Burke asked the Minister for Health the status of the recruitment of an orthodontic consultant for counties Longford and Westmeath; and if he will make a statement on the matter. [6085/18]
Amharc ar fhreagraAs this is a service matter it has been referred to the HSE for attention and direct reply to the Deputy.
75. Deputy Billy Kelleher asked the Minister for Health when he will bring forward the proposed changes to the nursing home support scheme; and if he will make a statement on the matter. [6398/18]
Amharc ar fhreagraWhen the NHSS commenced in 2009, a commitment was made that it would be reviewed after three years. The Report of the Review was published in July 2015. Arising out of the Review, a recommendation was made to examine the treatment of business and farm assets for the purposes of the financial assessment element of the Scheme. The programme for a Partnership Government has also committed to reviewing the NHSS to remove any discrimination against small businesses and family farms. I am committed to this review, however, it is important to remember that the NHSS is largely underpinned by primary legislation and changes to the NHSS will require legislative implementation.
On this basis, I requested legal advice from the office of the Attorney General regarding potential changes to the legislation that will address this matter. The Department has recently received this advice and are exploring the legislative changes necessary and any potential impacts as a result of amending the scheme. It is hoped to bring a Memo to Government on this issue shortly and subject to Government approval and the drafting process, I then hope to bring forward these legislative proposals thereafter.
76. Deputy Gino Kenny asked the Minister for Health if a decision has been made by the HSE on the drug, Kuvan, for those that are living with PKU; and if he will make a statement on the matter. [6094/18]
Amharc ar fhreagra186. Deputy John Brassil asked the Minister for Health the position regarding the reimbursement of Kuvan by the HSE after the recent drugs group meeting on 18 January 2018. [6495/18]
Amharc ar fhreagraI propose to take Questions Nos. 76 and 186 together.
The HSE has statutory responsibility for decisions on pricing and reimbursement of medicines under the community drug schemes, under the Health (Pricing and Supply of Medical Goods) Act 2013.
In reaching a decision, the HSE examines all the evidence which may be relevant in its view for the decision and will take into account such expert opinions and recommendations which it may have sought, including, for example, advice from the National Centre for Pharmacoeconomics (NCPE).
Sapropterin (Kuvan) was considered under the national pricing and reimbursement processes in 2009. At that time, insufficient evidence was available to support the pricing and reimbursement application submitted.
In 2016, the HSE was advised that a new health technology assessment dossier would be submitted on sapropterin. The NCPE completed its assessment of the new dossier in September 2017 and did not recommend sapropterin for reimbursement, as it was not deemed cost effective at the price sought by the company.
The Department of Health was advised that Sapropterin was discussed at the most recent HSE Drugs Group Meeting on the 18 January 2018. The Drugs Group was not in a position to make a recommendation to HSE Leadership following that meeting. It has sought additional information and deliberations are ongoing.
77. Deputy Martin Heydon asked the Minister for Health the updated timeframe for the refurbishment of the HSE-owned day care centre on Drogheda Street, Monasterevin, County Kildare further to the appointment of the design team for the project; and if he will make a statement on the matter. [6376/18]
Amharc ar fhreagraAs the HSE is responsible for the delivery of health care infrastructure projects, the Executive has been requested to reply directly to you in relation to the day care centre on Drogheda Street, Monasterevin, Co Kildare.
78. Deputy James Lawless asked the Minister for Health his plans in 2018 to address the lack of dedicated community neuro-rehabilitation teams in CHO7. [6416/18]
Amharc ar fhreagraThe 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 service matters, I have arranged for the question to be referred to the Health Service Executive (HSE) for direct reply to the Deputy.
79. Deputy Louise O'Reilly asked the Minister for Health if the HSE target of eliminating emergency department waiting times of greater than 24 hours for persons over 75 years of age were met for 2017; the number of persons over 75 years of age that have had a wait of more than 24 hours in an emergency department in 2017; the hospital in which the wait occurred; and if he will make a statement on the matter. [6366/18]
Amharc ar fhreagraIn relation to the particular query raised, as this is a service matter, I have asked the HSE to respond to you directly.
80. Deputy Billy Kelleher asked the Minister for Health if the 18-month target for outpatient waiting times announced in 2015 is still departmental policy; and if he will make a statement on the matter. [6395/18]
Amharc ar fhreagraReducing waiting times for patients is one of the Government's key priorities. Consequently, the HSE Outpatient Waiting List Action Plan 2017 contained a specific target to reduce by 50% the number of patients who would be waiting 15 months or more for outpatient appointments by the end of October 2017. The Plan aimed to remove over 95,000 patients from the Outpatient Waiting List. This target was met with almost 100,000 patients coming off the list by the week ending 3 November.
Notwithstanding, the Outpatient Waiting List remains a significant challenge to be addressed in 2018. Outpatient activity has increased year-on-year, while the gap between referrals and appointment activity continues to widen, with 2017 data from the HSE indicating a gap of over 1,200 patients per week. The HSE has also advised that almost half a million (479,000) outpatients did not attend their outpatient appointment last year. This is an area that must be tackled. A number of steps, including the commencement of a national waiting list validation project by the HSE, are being taken to ensure the lists are accurate. These efforts are to intensify in the coming months.
My Department has also requested the HSE to develop an Outpatient Waiting List Action Plan for 2018, building on progress achieved last year.
82. Deputy Louise O'Reilly asked the Minister for Health if he will meet with women affected by the side effects of the use of transvaginal mesh and their representatives; his plans to limit or ban the use of mesh as other countries have; the focus of the report into the use of mesh; the timeframe for same; and if he will make a statement on the matter. [6368/18]
Amharc ar fhreagraI am aware of the safety concerns that have been raised surrounding the use of Transvaginal mesh procedures. As Minister for Health, I want to ensure that both the current use of mesh implants in uro-gynaecological procedures in Ireland, and the on-going clinical management of women who have had these procedures in the past, are in line with international best practice and emerging evidence. At my request, the Chief Medical Officer is preparing a report on the many clinical and technical issues involved, including the issues raised at Leader’s Questions and in previous Parliamentary Questions on this topic. I am informed that this work involves engagement with national and international bodies, the professional colleges and others. This work is underway and will take a number of months to complete and I would ask the Deputy to await the outcome of that work.
I would have no objection to meeting with women affected and their representatives once this report to me is completed.
The Health Products Regulatory Authority (HPRA) advises that they are not aware of scientific evidence which concludes these devices are unsafe when used in line with their intended use. The HPRA continues to liaise closely with European Competent Authorities, the European Commission and with International regulatory agencies in relation to the international evidence relating to these devices. No regulatory action has been taken to date by Competent Authorities in any European country in respect of these devices.
The HPRA has also consulted with a number of clinical experts in this field. The advice of Dr. Suzanne O’Sullivan, President Continence Foundation of Ireland (www.continence.ie ) and Consultant Obstetrician and Urogynaecologist in Cork University Maternity Hospital is that “The MUS [mid-urethral sling] has become the operation of choice in Europe, Asia, North and South America and Australasia for treatment of stress urinary incontinence with several million procedures performed worldwide. Whilst each patient differs in terms of symptoms, background medical history, optimal treatment approaches may differ. Relative to other procedures mid urethral slings have been shown, in large studies from all over the world, to be no less safe (and usually more safe) than other procedures and with improved short, medium and long-term outcomes. These mesh slings have major advantages of shorter operating and admission times, and a quicker return to normal activities together with lower rates of complications”.
The safety of surgical meshes used in urogynecological surgery has also been reviewed in Europe by the Scientific Committee on Emerging and Newly Identified Health Risks (SCENIHR). SCENIHR was requested to provide a scientific Opinion on the safety of surgical meshes used in contemporary pelvic surgery. The Opinion of the SCENIHR was approved in December 2015 and is available, together with a summary of the outcome, on the website of the European Commission http://ec.europa.eu/health/scientific_committees/consultations/public_consultations/scenihr_consultation_27_en.
The SCENIHR summary outlines that ‘clinical outcome following mesh implantation is influenced by material properties, product design, overall mesh size, route of implantation, patient characteristics, associated procedures (e.g. hysterectomy) and the surgeon’s experience’.
SCENIHR states that ‘synthetic sling SUI surgery is an accepted procedure with proven efficacy and safety in the majority of patients with moderate to severe SUI, when used by an experienced and appropriately trained surgeon. Therefore, the SCENIHR supports continuing synthetic sling use for SUI, but emphasises the importance of appropriately trained surgeons and detailed counselling of patients about the associated risk/benefits’. SCENIHR also highlights that “the implantation of any mesh for the treatment of POP via the vaginal route should only be considered in complex cases, in particular, after failed primary repair surgery”.
The Department strongly advises that any woman who experiences or suspects that she has experienced a complication associated with TVMI surgery should discuss this with her GP or with the hospital from which she received the implant. The Department also advises that women considering surgery involving TVMIs should thoroughly discuss with their doctors the indications, alternatives (surgical and non-surgical), benefits and risks involved in their personal circumstances.
83. Deputy Ruth Coppinger asked the Minister for Health if he will report on the use of Mifepristone and Misoprostol for the termination of pregnancy here; and if he will make a statement on the matter. [6380/18]
Amharc ar fhreagraThere are no medicinal products with a marketing authorisation in Ireland for the termination of pregnancy. Literature indicates that mifepristone alone, or in combination with misoprostol, may be used for the medical termination of pregnancy, or for the induction of labour following miscarriage.
There are currently no medicinal products containing mifepristone authorised for use in Ireland. There are 2 medicinal products containing misoprostol-only, authorised for use in Ireland, neither of which have an indication for medical termination of a pregnancy as part of that marketing authorisation.
