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Tuesday, 17 Apr 2018

Written Answers Nos. 724-740

Pharmacy Services

Ceisteanna (724)

Jackie Cahill

Ceist:

724. Deputy Jackie Cahill asked the Minister for Health the direction he plans to give the HSE in relation to a matter (details supplied); when the instruction will be given; and if he will make a statement on the matter. [15269/18]

Amharc ar fhreagra

Freagraí scríofa

This report will be considered in the context of evaluation of pharmacy services for Irish public patients.

Hospital Staff Data

Ceisteanna (725)

Jack Chambers

Ceist:

725. Deputy Jack Chambers asked the Minister for Health the overtime rate for interns in each hospital in tabular form; and if he will make a statement on the matter. [15276/18]

Amharc ar fhreagra

Freagraí scríofa

I have asked the HSE to respond to you directly on this matter.

Mental Health Services Provision

Ceisteanna (726)

James Browne

Ceist:

726. Deputy James Browne asked the Minister for Health the counties that do not take emergency primary care psychology appointments; and if he will make a statement on the matter. [15284/18]

Amharc ar fhreagra

Freagraí scríofa

As this is a service matter I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.

Medicinal Products Availability

Ceisteanna (727, 741, 942, 979, 994)

Robert Troy

Ceist:

727. Deputy Robert Troy asked the Minister for Health the reason Versatis plasters and patches are not covered by the medical card. [15290/18]

Amharc ar fhreagra

Martin Heydon

Ceist:

741. Deputy Martin Heydon asked the Minister for Health the status of the work within his Department to address the concerns of users of the Versatis patches; and if he will make a statement on the matter. [15339/18]

Amharc ar fhreagra

Michael McGrath

Ceist:

942. Deputy Michael McGrath asked the Minister for Health the steps he is taking with the HSE to ensure that persons who need Versatis patches are receiving them; and if he will make a statement on the matter. [16260/18]

Amharc ar fhreagra

Seán Fleming

Ceist:

979. Deputy Sean Fleming asked the Minister for Health the status of the withdrawal of the Versatis patch for persons with chronic pain; the number of persons who have been approved for this patch since the beginning of 2018; the number of persons who no longer have approval for the patch; and if he will make a statement on the matter. [16442/18]

Amharc ar fhreagra

Peter Burke

Ceist:

994. Deputy Peter Burke asked the Minister for Health the reason Versatis patch has been refused for a person (details supplied) in view of the fact that alternative medications are having negative effects on them; if they can reapply again; and if he will make a statement on the matter. [16611/18]

Amharc ar fhreagra

Freagraí scríofa

I propose to take Questions Nos. 727, 741, 942, 979 and 994 together.

Medicines 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 a safe and sustainable manner. Treatment must be appropriate and proportionate and clinical decision-making, such as prescribing, should be based on both patient needs and sound medical evidence.

Lidocaine 5% medicated plasters are licensed for the localised relief of post-shingles pain in adults. This is the only licensed use for the patch in Ireland. It has been reimbursed in the community drugs schemes since 2010.

Clinical concern arose when, from 2012 on, usage increased significantly, to the point where, in Ireland, more plasters were being used in than the entire UK National Health Service. In such situations, it is important and appropriate for clinicians to review usage and, in 2016, the HSE Medicines Management Programme (MMP) reviewed the use of the plasters. The review estimated that only 5-10% of prescribing was for the licensed indication.

Following the clinical review, the HSE introduced a new reimbursement approval system for the patches from September 2017, to support appropriate use and patient care. Under these arrangements, the patient's GP or consultant must apply to the MMP for reimbursement approval on behalf of the patient. In the case of a negative reimbursement decision, the treating clinician can appeal the decision. Once a patient is approved for reimbursement support, irrespective of the indication, there will be no expiry on the duration of treatment. This also applies to applications already approved by the MMP.

As of 29 March 2018, there have been 5,747 online applications from clinicians requesting the reimbursement of Versatis. Of these applications, 1,205 patients (over 21%) have been approved. Of 672 online appeals, over 71% of patients have been approved for reimbursement. The MMP has sought further information on another 41 appeals. Accordingly, since 1 September 2017, 1,681 patients have been approved for reimbursement of lidocaine plasters, based on the clinical case made by their GP or consultant.

It is clear that this new process supports appropriate use and prescribing and both post-shingles patients and other appropriate cases can continue to be treated with lidocaine plasters.

The HSE notified prescribers and pharmacies of the introduction of the new system in August 2017. This advice was re-issued recently, and information for patients and practitioners is on the HSE Medicines Management Programme website at www.hse.ie/yourmedicines.

This reimbursement decision is a matter for the HSE. However, I fully support the objectives of the HSE Medicines Management Programme.

Hospital Appointments Status

Ceisteanna (728)

Niamh Smyth

Ceist:

728. Deputy Niamh Smyth asked the Minister for Health the status of a surgical procedure for a person (details supplied); if a date for this appointment will be provided; and if he will make a statement on the matter. [15294/18]

Amharc ar fhreagra

Freagraí scríofa

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 the Deputy directly.

Hospital Consultant Recruitment

Ceisteanna (729)

Billy Kelleher

Ceist:

729. Deputy Billy Kelleher asked the Minister for Health the reason for the delay in finding a replacement for a person (details supplied) who has retired; if there is a start date for a new consultant; the steps he is taking to alleviate the waiting list; and if he will make a statement on the matter. [15310/18]

Amharc ar fhreagra

Freagraí scríofa

As this is a service matter, I have asked the Health Service Executive to respond to you directly as soon as possible.

Primary Care Centres Provision

Ceisteanna (730)

Catherine Connolly

Ceist:

730. Deputy Catherine Connolly asked the Minister for Health further to Parliamentary Question No. 389 of 26 September 2017 and further to a request made by the HSE to the islands division to acquire an identified site for a replacement primary health centre on Inishbofin, County Galway, the progress made in relation to the acquisition of the site; and if he will make a statement on the matter. [15314/18]

Amharc ar fhreagra

Freagraí scríofa

As 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 a replacement primary care centre on Inishbofin, County Galway.

Mental Health Services Staff

Ceisteanna (731)

Tony McLoughlin

Ceist:

731. Deputy Tony McLoughlin asked the Minister for Health his plans to reinstitute the position of a full time psychiatric nurse at the health centre in Easkey, County Sligo in view of the inadequacy of the health centre’s system of two half days a week with a psychiatric nurse and the existence previously of a full time psychiatric nurse; and if he will make a statement on the matter. [15324/18]

Amharc ar fhreagra

Freagraí scríofa

As this is a service matter I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.

Mental Health Services Staff

Ceisteanna (732)

Tony McLoughlin

Ceist:

732. Deputy Tony McLoughlin asked the Minister for Health if more extensive supervisory staff for mentally ill and vulnerable persons will be provided in view of the recent murder in County Sligo by a mentally ill man; and if he will make a statement on the matter. [15325/18]

Amharc ar fhreagra

Freagraí scríofa

As this is a service matter I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.

Emergency Planning

Ceisteanna (733)

Tony McLoughlin

Ceist:

733. Deputy Tony McLoughlin asked the Minister for Health the reason health centres in west County Sligo were told by the HSE not to provide dinners in the centres to old and vulnerable persons during Storm Emma; and if he will make a statement on the matter. [15326/18]

Amharc ar fhreagra

Freagraí scríofa

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.

Nursing Homes Support Scheme

Ceisteanna (734)

Brendan Howlin

Ceist:

734. Deputy Brendan Howlin asked the Minister for Health if his attention has been drawn to the concerns of nursing home owners in relation to the disparity of fees payable under the fair deal scheme between HSE and private nursing homes in County Wexford (details supplied); and if he will make a statement on the matter. [15328/18]

Amharc ar fhreagra

Freagraí scríofa

The Nursing Homes Support Scheme (NHSS), commonly referred to as Fair Deal, is a system of financial support for people who require long-term residential care. Participants contribute to the cost of their care according to their means while the State pays the balance of the cost. The Scheme aims to ensure that long-term nursing home care is accessible and affordable for everyone and that people are cared for in the most appropriate settings.

The Report of the NHSS Review published in 2015 identified a number of issues for more detailed consideration, including a review of pricing mechanism by the NTPF, with a view to:

- Ensuring value for money and economy, with the lowest possible administrative costs for clients and the State and administrative burden for providers;

- Increasing the transparency of the pricing mechanism so that existing and potential investors can make as informed decisions as possible; and

- Ensuring that there is adequate residential capacity for those residents with more complex needs.

A Steering Committee has been established to oversee this review which is chaired by the NTPF and includes representatives from my Department and the Department of Public Expenditure and Reform. The NTPF has responsibility for the development of this report, although Department Officials continue to engage with the NTPF regarding the review. The most recent update from the NTPF is that the report will be finalised and ready for review in the first half of 2018.

In relation to variations in the cost of care for public and private nursing homes it is acknowledged that public nursing homes have, in general, a higher cost of care.  It is understood that a number of factors contribute to this such as; higher dependency levels of clients requiring a higher staff skill mix, environmental implications for staffing levels and the geographical provision of residential placements.

That said, there is a need to undertake a deeper analysis of the factors driving the higher costs of care in public units. This is why the 2015 Review of the Nursing Homes Support Scheme identified the need for a Value for Money and Policy (VFM) review of the cost differentials in public and private / voluntary residential facilities. My Department will be working on this VFM throughout the year. 

Health Services Provision

Ceisteanna (735, 780, 853, 858, 929, 935, 956, 1001, 1002, 1038)

James Browne

Ceist:

735. Deputy James Browne asked the Minister for Health if his Department or the HSE are examining ways to ensure that persons with conditions such as multiple sclerosis, MS, have timely access to life changing medicines here; and if he will make a statement on the matter. [15331/18]

Amharc ar fhreagra

Catherine Murphy

Ceist:

780. Deputy Catherine Murphy asked the Minister for Health his plans to engage with an organisation (details supplied) and the pharmaceutical industry to ensure new medicines are available to persons with MS; and if he will make a statement on the matter. [15604/18]

Amharc ar fhreagra

John Curran

Ceist:

853. Deputy John Curran asked the Minister for Health if his Department and the HSE are engaging with an organisation (details supplied) and the pharmaceutical industry to ensure new medicines are made available to persons with MS. [15765/18]

Amharc ar fhreagra

Thomas Pringle

Ceist:

858. Deputy Thomas Pringle asked the Minister for Health his plans to engage with an organisation (details supplied) and the pharmaceutical industry to ensure that new medicines are available to persons with MS in a timely manner; the efforts he has carried out to date to ensure new medicines are available in a timely manner to those that need them most; and if he will make a statement on the matter. [15784/18]

Amharc ar fhreagra

Richard Boyd Barrett

Ceist:

929. Deputy Richard Boyd Barrett asked the Minister for Health the engagement he has had with an organisation (details supplied) and the pharmaceutical industry to ensure that new medicines are available to persons with MS; and if he will make a statement on the matter. [16163/18]

Amharc ar fhreagra

Michael Healy-Rae

Ceist:

935. Deputy Michael Healy-Rae asked the Minister for Health his plans to address concerns (details supplied) regarding MS and drug access; and if he will make a statement on the matter. [16218/18]

Amharc ar fhreagra

Tom Neville

Ceist:

956. Deputy Tom Neville asked the Minister for Health his views on a matter (details supplied) relating to persons with MS raised in correspondence; and if he will make a statement on the matter. [16363/18]

Amharc ar fhreagra

Eugene Murphy

Ceist:

1001. Deputy Eugene Murphy asked the Minister for Health his plans to engage with an organisation (details supplied) and the pharmaceutical industry to ensure new and effective medicines are available to persons with MS through a fair and sustainable system; and if he will make a statement on the matter. [16627/18]

Amharc ar fhreagra

Eugene Murphy

Ceist:

1002. Deputy Eugene Murphy asked the Minister for Health the reason the provision of new and effective medicines for MS patients undergoes such a lengthy waiting period compared to other European countries; and if he will make a statement on the matter. [16628/18]

Amharc ar fhreagra

Jim O'Callaghan

Ceist:

1038. Deputy Jim O'Callaghan asked the Minister for Health the steps that can be taken to speed up the process whereby patients with multiple sclerosis can gain access to life changing medicines; and if he will make a statement on the matter. [16799/18]

Amharc ar fhreagra

Freagraí scríofa

I propose to take Questions Nos. 735, 780, 853, 858, 929, 935, 956, 1001, 1002 and 1038 together.

The HSE has statutory responsibility for medicine pricing and reimbursement decisions, in accordance with the Health (Pricing and Supply of Medical Goods) Act 2013.   As Minister for Health, I do not have any statutory power or function in relation to the reimbursement of medicines. The Act specifies the criteria for decisions on the reimbursement of medicines.

In line with the 2013 Act, if a company would like a medicine to be reimbursed by the HSE pursuant to the Community Drugs scheme, the company must first submit an application to the HSE to have the new medicine added to the Reimbursement List.

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.

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.

The HSE strives to reach a decision in as timely a manner as possible. 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 on-going basis. This can lead to a protracted deliberation process.

I have been informed that the NCPE is currently conducting health technology assessments for Ocrelizumab for the treatment of adult patients with early primary progressive multiple sclerosis (PPMS) and for the treatment of adult patients with relapsing forms of multiple sclerosis (RMS).

I am keen to engage with Industry and to explore ways in which new medicines might be more easily introduced in Ireland.  However, any innovative approaches that may be tabled must be compatible with the statutory provisions which are in place and must also recognise the fundamental pricing/funding issues in the context of finite Exchequer resources. 

I have indicated willingness to meet with MS Ireland and my office is in contact with the organisation to arrange a mutually convenient date.

General Medical Services Scheme

Ceisteanna (736)

Seán Haughey

Ceist:

736. Deputy Seán Haughey asked the Minister for Health if his attention has been drawn to the fact that many general practitioners' practices particularly in the north County Dublin area are charging persons with medical cards or doctor visit cards for routine blood tests deemed clinically necessary by their general practitioners; the steps he will take to prevent this practice; and if he will make a statement on the matter. [15332/18]

Amharc ar fhreagra

Freagraí scríofa

Under the terms of the current GMS contract, GPs are required to provide eligible patients with  ''all proper and necessary treatment of a kind usually undertaken by a general practitioner and not requiring special skill or experience of a degree or kind which general practitioners cannot reasonably be expected to possess." There is no provision under the GMS GP contract for persons who hold a medical card or GP visit card to be charged for routine phlebotomy services provided by their GP which are required to either assist in the diagnosis of illness or the treatment of a condition.

The HSE has advised GPs that where a blood test forms part of the investigation or necessary treatment of a patient’s symptoms or conditions, this should be free of charge for patients who hold a medical card or GP visit card. Notwithstanding this, I am aware that some GPs have begun to charge GMS patients for phlebotomy services in some circumstances.

This is a matter of concern for me as it has long been the position, under successive Governments, that no user charges should apply to GP services provided to GMS and GP visit card patients.  If a patient who holds a medical card or GP visit card believes he or she has been incorrectly charged for routine phlebotomy services by his or her GP, then that patient may take the matter up with their HSE Local Health Office, who will investigate the complaint.

If the local office determines that the charge was inappropriate, it will inform the HSE Primary Care Reimbursement Service who will arrange to refund the cost of the blood test to the patient and recoup this amount from the GP. The local office will inform the GP of the decision to deduct the payment.

Long-Term Illness Scheme Coverage

Ceisteanna (737)

John Brassil

Ceist:

737. Deputy John Brassil asked the Minister for Health the plans in place to extend the FreeStyle Libre glucose monitoring system to the entire population for persons with type 1 diabetes on the long-term illness scheme; if no plans are in place, if the monitoring system will be extended; and if he will make a statement on the matter. [15333/18]

Amharc ar fhreagra

Freagraí 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.

Mental Health Services Data

Ceisteanna (738)

James Browne

Ceist:

738. Deputy James Browne asked the Minister for Health the number of children in each community healthcare organisation, CHO, area who were awaiting a child and adolescent mental health service, CAMHS appointment in June 2017; and if he will make a statement on the matter. [15336/18]

Amharc ar fhreagra

Freagraí scríofa

As this is a service matter I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.

Mental Health Services Data

Ceisteanna (739)

James Browne

Ceist:

739. Deputy James Browne asked the Minister for Health the number of persons in each community healthcare organisation, CHO, area who were awaiting a primary care psychology appointment in June 2017; and if he will make a statement on the matter. [15337/18]

Amharc ar fhreagra

Freagraí scríofa

As this is a service matter I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.

Mental Health Services Expenditure

Ceisteanna (740)

James Browne

Ceist:

740. Deputy James Browne asked the Minister for Health the amount of agency fees spent within mental health services from June 2017 to December 2017 inclusive; and if he will make a statement on the matter. [15338/18]

Amharc ar fhreagra

Freagraí scríofa

As this is a service matter I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.

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