Peadar Tóibín
Ceist:418. Deputy Peadar Tóibín asked the Minister for Health if a doctor has been convicted for terminating a pregnancy in a case in which he or she thought that the life of the mother was threatened. [12823/18]
Amharc ar fhreagraAbortion Legislation
Ceisteanna (418, 419, 420, 421, 422)
Peadar Tóibín
Ceist:419. Deputy Peadar Tóibín asked the Minister for Health if charges have been brought against a doctor for terminating a pregnancy in a case in which he or she thought that the life of the mother was threatened. [12824/18]
Amharc ar fhreagraPeadar Tóibín
Ceist:420. Deputy Peadar Tóibín asked the Minister for Health if a doctor has been arrested for terminating a pregnancy in a case in which he or she thought that the life of the mother was threatened. [12825/18]
Amharc ar fhreagraPeadar Tóibín
Ceist:421. Deputy Peadar Tóibín asked the Minister for Health if there has ever been an investigation into a doctor for terminating a pregnancy in a case in which he or she that the life of the mother was threatened. [12826/18]
Amharc ar fhreagraPeadar Tóibín
Ceist:422. Deputy Peadar Tóibín asked the Minister for Health if complaints have been reported to An Garda Síochána that a doctor was acting outside the law for terminating a pregnancy in which he or she thought that the life of the mother was threatened. [12827/18]
Amharc ar fhreagraFreagraí scríofa
I propose to take Questions Nos. 418 to 422, inclusive, together.
I am not aware of any investigations, complaints to An Garda Síochána, arrests, convictions, or charges, as outlined by the Deputy, as these matters are not the responsibility of my Department.
The Protection of Life During Pregnancy Act 2013 regulates access to a termination of pregnancy, if a pregnant women’s life is at risk from a threat to her physical or mental health.
Under the 2013 Act, medical procedures in respect of a pregnant woman, which result in the ending of an unborn human life, are lawful in three specified categories of circumstances: (1) Risk of loss of life from physical illness, (2) Risk of loss of life from physical illness in emergency and (3) Risk of life from suicide.
Departmental Banking
Ceisteanna (423)
Pearse Doherty
Ceist:423. Deputy Pearse Doherty asked the Minister for Health the cost to his Department of negative interest rates on deposits held; the details of same for agencies under his aegis; and if he will make a statement on the matter. [11739/18]
Amharc ar fhreagraFreagraí scríofa
The total amount of negative interest charges paid by my Department is €785.29.
Operational matters such as this, relating to agencies under the aegis of my Department, are a matter for the agency itself and the Deputy should contact the relevant CEO, Chairman or Registrar of the agency concerned, as appropriate.
Departmental Advertising Expenditure
Ceisteanna (424)
Catherine Murphy
Ceist:424. Deputy Catherine Murphy asked the Minister for Health the amount spent by his Department on third party public relations advice, communications advice, online advertising and public awareness campaigns from January 2017 to date in 2018, by year, month and company engaged in tabular form; and if he will make a statement on the matter. [11769/18]
Amharc ar fhreagraFreagraí scríofa
It is the policy in my Department only to engage the services of external consultants where it is felt to be appropriate and cost-effective, taking account of Government decisions and policy including procurement protocols on the matter.
The Department does not collect data in a manner which would allow the Deputy’s question to be answered in full. However, expenditure detail on public relations and communications advice by the Department in 2017 is as follows:
|
Year |
Event |
Agency |
Cost € |
|
2017 |
PR and communications support re Ireland's bid for the European Medicines Agency |
Hume Brophy |
114,491 |
I will revert to the Deputy with information regarding the other expenditure requested as soon as it is available.
Gender Recognition
Ceisteanna (425, 426, 428, 430)
Niamh Smyth
Ceist:425. Deputy Niamh Smyth asked the Minister for Health if there is a requirement of a psychiatric diagnosis for persons when seeking hormone replacement therapy; and if so, the reason this is deemed necessary. [11780/18]
Amharc ar fhreagraNiamh Smyth
Ceist:426. Deputy Niamh Smyth asked the Minister for Health if there are two physicians only willing to prescribe hormone replacement therapy here. [11781/18]
Amharc ar fhreagraNiamh Smyth
Ceist:428. Deputy Niamh Smyth asked the Minister for Health if his attention has been drawn to the fact that a requirement of psychiatric diagnosis for hormone replacement therapy is viewed as offensive by the transgender community. [11783/18]
Amharc ar fhreagraNiamh Smyth
Ceist:430. Deputy Niamh Smyth asked the Minister for Health if the diagnostic model for hormone replacement therapy will be abolished. [11785/18]
Amharc ar fhreagraFreagraí scríofa
I propose to take Questions Nos. 425, 426, 428 and 430 together.
Transgender-specific guidelines have been developed by WPATH, World Professional Association for Transgender Health, and the Endocrine Society, that updated its guidelines in 2017. These guidelines were devised by experts in transgender healthcare, along with members of the International Transgender, Transsexual and LGBT community.
A proposed model of care for transgender children, adolescents and adults was submitted by the HSE Quality Improvement Division to the HSE Divisions of Primary Care, Mental Health and Acute Hospital programme. The model was developed in consultation with key treating clinicians, planners, policy makers, advocates and service users.
The guidelines recommend a comprehensive multidisciplinary psychosocial assessment prior to commencement of hormone therapy by endocrinology services. The assessment focuses on more than just assessment for the possible diagnosis of Gender Dysphoria. The guidelines highlight several criteria which must be met prior to referral for hormonal intervention. It is important that co-morbid conditions are identified and addressed, and that people access the supports that they need to manage co-morbid difficulties, which can impact on response to medical transition (including hormone treatment).
International best practice involves an assessment by a multi-disciplinary team and shared decision making in the best interests of the individual. Both WPATH and the Endocrine Society Guidelines 2017 specify the assessment must be carried out by a mental health professional (s) with experience in transgender healthcare and possess specific skills. Endocrinologists and General Practitioners, GPs, do not possess these skills, and require access to the multidisciplinary team as described. GPs would only see a small number of gender variant individuals during their lifetime in clinical practice, and would not be in a position to build up the requisite skillset outlined in WPATH and Endocrine Society Guidelines or have the time resource to conduct a comprehensive evaluation.
Informed consent is essential, whereby benefits and risks of hormone treatment and surgery are discussed with individuals seeking these interventions. Although regret rates are low, it can happen and can also lead to high levels of psychological distress. Healthcare providers work with people to try to prevent negative outcomes. The emerging evidence on good outcomes following medical and/or surgical transitioning is based on use of multi-disciplinary psychosocial assessment, fulfilment of criteria for hormones and on-going psychological support throughout the process. It is important that psychological support is available to individuals before, during and after transitioning.
Prescription of hormone blockers and cross-sex hormones for transgender people is relatively new. Significant side effects can occur with cross sex hormones including irreversible physical changes and infertility. There is a lack of long-term research on outcomes. For these reasons the decision to prescribe should only be made by specialists, i.e. Endocrinologists, in consultation with other professionals involved in the assessment process. Shared decision-making is in accordance with best practice internationally. Prescriptions can then be supported by local GPs with specialist guidance.
The model of care is providing the framework for the development of National Gender Clinics and MDTs for children and adults, funded by the Acute Hospitals and Mental Health Divisions of the HSE. Recruitment will commence to develop these national teams in 2018. It is envisaged that these National Teams will be in place in 2018, pending successful recruitment campaigns.
The HSE, across a number of programmes including mental health, acute hospitals, primary care and social inclusion, is committed to building services for this community in accordance with International Best Practice.
Health Services Data
Ceisteanna (427)
Niamh Smyth
Ceist:427. Deputy Niamh Smyth asked the Minister for Health the number of persons in each local health office area that are waiting for hormone replacement therapy; and the number waiting less than one year, one to two years and more than two years for same. [11782/18]
Amharc ar fhreagraFreagraí scríofa
In relation to the particular query raised, as this is a service matter, I have asked the HSE to respond to the Deputy directly.
Question No. 428 answered with Question No. 425.
General Practitioner Training
Ceisteanna (429)
Niamh Smyth
Ceist:429. Deputy Niamh Smyth asked the Minister for Health if general practitioner education on transgender healthcare will be rolled out nationwide. [11784/18]
Amharc ar fhreagraFreagraí scríofa
The Irish College General Practitioners, ICGP, is the professional body for general practice in Ireland and is responsible for post graduate specialist medical education, training and research in the specialty of general practice.
The ICGP’s curriculum for general practice training involves teaching trainees to:
- Recognise that patients are diverse;
- Initiate systems to make the GP practice approachable to all women including for lesbian, bisexual and transgender patients;
- Describe the health needs of gay, transgender and bisexual men, beyond sexual health, and their partners;
- Acknowledge the role of the GP in gay, lesbian, bisexual and transgender health care.
The ICGP also provides continuous medical education to General Practitioners in the form of journals, e-learning, quick reference guides, small group meetings and conferences. The ICGP is also currently updating the College’s quick reference guide on LGBT health issues in conjunction with LGBT Ireland. This will be published later in 2018.
There are currently no plans to roll out a national programme of education on transgender healthcare.
Medicinal Products Availability
Ceisteanna (431)
Róisín Shortall
Ceist:431. Deputy Róisín Shortall asked the Minister for Health his plans to address the medicine supply and affordability issues highlighted in correspondence (details supplied); the reason the medicines in question cannot be obtained through a medical card; and if a reimbursement is possible [11786/18]
Amharc ar fhreagraFreagraí scríofa
Under the Health (Pricing and Supply of Medical Goods) Act 2013, the HSE has statutory responsibility for the administration of the community drug schemes; therefore, the matter has been referred to the HSE for attention and direct reply to the Deputy.
Disability Services Provision
Ceisteanna (432)
Marcella Corcoran Kennedy
Ceist:432. Deputy Marcella Corcoran Kennedy asked the Minister for Health the reason a person (details supplied) did not continue to receive an equivalent monthly payment following the withdrawal of the mobility allowance and motorised transport grant schemes in February 2013; and if he will make a statement on the matter. [11787/18]
Amharc ar fhreagraFreagraí scríofa
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.
Home Help Service Data
Ceisteanna (433)
James Lawless
Ceist:433. Deputy James Lawless asked the Minister for Health if a delay in awarding home help hours to a person (details supplied) will be investigated; if a decision on the awarding of these hours will be expedited; and if he will make a statement on the matter. [11795/18]
Amharc ar fhreagraFreagraí scríofa
As this is a service matter I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.
Rare Diseases Strategy
Ceisteanna (434)
Mary Butler
Ceist:434. Deputy Mary Butler asked the Minister for Health the elements of the National Rare Disease Plan 2014 that have been implemented; and his plans to protect children with rare diseases here. [11822/18]
Amharc ar fhreagraFreagraí scríofa
Rare diseases are often diagnosed in childhood and are a significant cause of disability. The recommendations of the National Plan, published in 2014, apply to all age groups within the population but in particular for children.
In 2017 the Department published a progress report on the National Rare Disease Plan and this is available on the Department’s website under ‘Publications’. An update is provided on all 48 recommendations of the Plan and on progress to date.
Establishment of a National Clinical Programme for Rare Diseases was one of the principal recommendations in the Plan. The Programme is responsible for assisting with mapping and developing care pathways for rare diseases; facilitating timely access to centres of expertise- nationally and internationally; and developing care pathways with European Reference Centres for those ultra-rare disorders where there may not be sufficient expertise in Ireland.
In line with the National Rare Diseases Plan, the National Clinical Programme for Rare Diseases and the Department of Health, encouraged designated centres of expertise in Ireland to apply for membership of European Reference Networks, ERNs, during the first round of calls from the European Commission for participation in European Reference Networks. Three of these centres are now represented on ERN network.
Membership of ERNs will bring opportunities for engaging in research relating to Rare Diseases in keeping with the National Rare Diseases Plan. Further centres are expected to apply for membership or affiliated membership of ERNs when the next call takes place in early 2018.
The establishment of a National Rare Disease Office, NRDO, was a key recommendation of the Rare Disease plan. The office provides current and reliable information about rare diseases to the general public, health care professionals, researchers and policy makers. The National Rare Diseases Office is responsible for updating Orphanet Ireland. Orphanet is the international rare disease reference and information portal funded by the EU. The office also manages the National Rare Diseases Information Line, freephone service, and provides online information about rare diseases on their website.
A number of recommendations about access to appropriate drugs and technologies were contained in the plan. One chief recommendation in this regard refers to the HSE developing a Working Group to bring forward appropriate decision criteria for the reimbursement of orphan medicines and technologies; and that the approach should include an assessment system similar to that for cancer therapies established under the National Cancer Control Programme. The HSE Acute Hospitals Division has developed the terms of reference, required membership and reporting relationship for this committee. A Chairperson has now been identified and it is expected that the Group will convene in early 2018.
One of the recommendations of the National Plan for Rare Diseases was that the Health Identifiers Bill and the Health & Patient Safety Bill be published. The former was published in 2013 and enacted in 2014. The Individual Health Identifier part of the project is now being implemented by the HSE. A revised and much expanded General Scheme of a Health Information and Patient Safety Bill was approved by the government in November 2015 and published on the Department's website.
Two recommendations referred to training in rare diseases for healthcare professionals. The Department of Health has contacted formally the various healthcare representative and professional bodies about implementing these recommendations. The National Rare Diseases Office developed eLearning modules for healthcare professionals. These modules are available on HSE website.
The issue of rare diseases and of the creation of an all-island patient register has been raised in the context of on-going discussions at North-South meetings. It is also anticipated that the Model of Care for Rare Diseases will set out recommendations for rare disease registries. This model of care is in development by the National Clinical Programme for Rare Diseases. At the EU level, the Joint Research Centre is developing a joint European Platform on Rare Disease Registration which will promote EU level standards for data collection and contribute to the development of rare disease registries across the EU.
The Plan also recommended that an Oversight Implementation Group of relevant stakeholders, including patients' groups, be established to oversee and monitor implementation of the plan’s recommendations. This group was established by the Department of Health in 2015 and it has met on a number of occasions.
The National Rare Disease Plan continues to be implemented. The Department will consider the matter of a further plan as part of its Work Programme for 2018.