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Tuesday, 17 Apr 2018

Written Answers Nos. 759-774

Departmental Staff Grades

Ceisteanna (759)

James Browne

Ceist:

759. Deputy James Browne asked the Minister for Health the number of staff at AP level working in his Department by actual numbers and whole-time equivalents; and if he will make a statement on the matter. [15439/18]

Amharc ar fhreagra

Freagraí scríofa

The number of staff at Assistant Principal Officer level working in my Department at end March 2018 is detailed as follows:

GRADE

HEADCOUNT

Whole time equivalent (WTE)

Assistant Principal

108

103.13

Assistant Principal Equivalent

21

20.8

TOTAL

129

123.93

Health Services Provision

Ceisteanna (760)

Louise O'Reilly

Ceist:

760. Deputy Louise O'Reilly asked the Minister for Health the status of the Alzheimer’s unit located in a day centre (details supplied) in Dublin 15; his views on concerns that the HSE is planning to cut funds for staff working in the unit; and if he will make a statement on the matter. [15445/18]

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.

Nursing Homes Support Scheme Administration

Ceisteanna (761)

Michael Healy-Rae

Ceist:

761. Deputy Michael Healy-Rae asked the Minister for Health if he will address issues with regard to the fair deal scheme (details supplied); and if he will make a statement on the matter. [15455/18]

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.

With regard to the Deputy’s question on plans to introduce an independent appeal mechanism within the NHSS to provide third party recourse for nursing home providers that cannot agree a fee with the NTPF, I cannot nor would I wish to, prejudge the outcomes of the NTPF pricing mechanism review. However I welcome the work to date and look forward to the NTPF concluding the review later this year.

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. 

Hospital Services

Ceisteanna (762)

Seán Fleming

Ceist:

762. Deputy Sean Fleming asked the Minister for Health when the consultation process being conducted by his Department in respect of the delivery of clinical services at the Midlands Regional Hospital, Portlaoise, will commence; the person chairing this process; when meetings with local clinicians and the community will take place; the timeline for the conclusion of this process; and if he will make a statement on the matter. [15462/18]

Amharc ar fhreagra

Freagraí scríofa

It remains the case, as outlined at my meeting with you and the other Laois Oireachtas members in December 2017, that no decision has been made yet on the draft Action Plan for Portlaoise Hospital. I have asked my Department to conduct a consultation process in this regard involving local clinicians and the community and this is currently under consideration.

General Practitioner Services Provision

Ceisteanna (763, 764)

Brendan Ryan

Ceist:

763. Deputy Brendan Ryan asked the Minister for Health his views on the lack of general practitioners here with particular reference to the lack of same in the Fingal area of County Dublin; and the strategies in place to ensure an adequate number of general practitioners is available in Fingal and throughout the State. [15468/18]

Amharc ar fhreagra

Brendan Ryan

Ceist:

764. Deputy Brendan Ryan asked the Minister for Health the number of general practitioner practices in the Fingal area of County Dublin; the number of these practices that are not accepting new patients; and if he will make a statement on the matter. [15470/18]

Amharc ar fhreagra

Freagraí scríofa

I propose to take Questions Nos. 763 and 764 together.

The Government is committed to delivering more non-acute care within the primary care sector, so that better care closer to home can be provided for communities around the country.

GPs play an important role in the primary care system.  The number of GPs on the specialist register continues to increase – up from 2,270 in 2010 to 3,637 in 2017 and there are now 2,485 GPs contracted to the HSE under the GMS scheme compared to 2,098 in 2008. It should be noted that as of 1 March there were only 23 GMS panels that do not have a permanent GP in place – a vacancy rate of less than 1%.

The Government is committed to increasing GP capacity to ensure that patients across the country continue to have access to GP services and that general practice is sustainable in all areas into the future. Efforts undertaken in recent years to increase the number of practising GPs include changes to the entry provisions to the GMS scheme to accommodate more flexible/shared GMS/GP contracts, and to the retirement provisions for GPs under the GMS scheme, allowing GPs to hold GMS contracts until their 72nd birthday, as well as the introduction of an enhanced supports package for rural GP practices.

In addition, the Government has also taken steps to expand GP training. In 2009, there were 120 GP training places. This year there are over 190 GP training places available for the 2018 GP training intake. The Government is committed to further increasing this number to 259 places annually in future years.

It is generally accepted that there is a need to modernise the current GMS contract and ensure that general practice benefits patients while providing for a viable and rewarding career for current and future GPs. The aim is to develop a contract which has a population health focus, providing in particular for health promotion and disease prevention and for the structured ongoing care of chronic conditions.

Engagement with GP representatives on contractual issues will commence in the coming weeks. It is important that any new contract will result in service improvements across general practice benefitting both patients and GPs.

In relation to the Deputy's specific questions about general practice services in the Fingal area, as these relate to service matters, I have arranged for the questions to be referred to the Health Service Executive for direct reply to the Deputy.

Palliative Care Services Provision

Ceisteanna (765)

Brendan Howlin

Ceist:

765. Deputy Brendan Howlin asked the Minister for Health if palliative care in the home will be provided for a person (details supplied); and if he will make a statement on the matter. [15475/18]

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 Reimbursement

Ceisteanna (766)

Clare Daly

Ceist:

766. Deputy Clare Daly asked the Minister for Health the steps he will take to reduce the lead-in time for reimbursement of a new medicine by the HSE in order to ensure speedy access to new and effective treatments through a fair and sustainable system for persons who need them. [15476/18]

Amharc ar fhreagra

Freagraí scríofa

The 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. 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.

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 make a formal decision.

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.

Nursing Homes Support Scheme

Ceisteanna (767)

Jackie Cahill

Ceist:

767. Deputy Jackie Cahill asked the Minister for Health if he will address issues in the case of a person (details supplied); and if he will make a statement on the matter. [15491/18]

Amharc ar fhreagra

Freagraí scríofa

Participants in the Nursing Homes Support Scheme (NHSS) contribute up to 80% of their assessable income and a maximum of 7.5% per annum of the value of assets held. In the case of a couple, the applicant’s means are assessed as 50% of the couple’s combined income and assets.  The first €36,000 of an individual’s assets, or €72,000 in the case of a couple, is not counted at all in the financial assessment.  The capital value of an individual’s principal private residence is only included in the financial assessment for the first three years of their time in care.  This is known as the three year cap.

The following safeguards for participants to the scheme apply:

- In the case of a couple, the applicant’s means are assessed as 50% of the couple’s combined income and assets.

- The principal private residence is only assessed for a maximum of three years;

- The first €36k of an individual’s assets, or €72k of a couple’s assets, is not included in the financial assessment.

- An applicant will keep at least 20% of his/her income or of the non-Contributory State Pension, whichever is the greater. If both members of a couple are in nursing home care, they each retain 20% of the relevant income figure.

- No one pays more than the actual cost of their care.

- Eligibility for other Schemes (Medical Card etc) is unaffected by participation in the NHSS.

Certain payments, termed allowable deductions can be taken into account during the financial assessment stage of the application process. It is the responsibility of the applicant to request any such deductions and to provide the information that the HSE will require in order to permit a deduction.

Allowable deductions include health expenses, interest on loans related to the principal residence and rent if the participant lives in rented accommodation. When determining income, the following deductions apply:

1: Income tax, social insurance contributions and statutory levies shall be deducted (net of allowances, reliefs and exemptions which the applicant or any other person might be entitled to claim)

2: Where an applicant owns their principal residence, either (a) interest on borrowings or (b) borrowings incurred to the extent that such amount has not been repaid, for the purchase, repair or improvement of the principal residence shall be deducted. Where an individual chooses to avail of (b), he or she cannot also seek to offset the same mortgage against the value of the asset concerned.

 Where an applicant is a tenant, rental payments in respect of the residence shall be deducted where the applicant’s spouse/partner or a child under 21 of the couple lives in the residence. Deductions in respect of interest on borrowings/unpaid borrowings and in respect of rent are mutually exclusive and may not both be made in respect of the same applicant. These allowable deductions should allow for any relief from income tax which may be claimed in respect of such payments.

3: Health expenses within the meaning of section 469 of the Taxes Consolidation Act 1997 shall be deducted, excluding contributions payable under the Nursing Homes Support Scheme, but such deductions shall be net of any tax relief claimed by the applicant or their spouse or relative.

Abortion Services Provision

Ceisteanna (768, 769, 770)

Éamon Ó Cuív

Ceist:

768. Deputy Éamon Ó Cuív asked the Minister for Health if he has had discussions with the representative organisations representing general practitioners regarding his proposal to deliver a general practitioner led abortion service up to 12 weeks of gestation; if they have agreed in principle to provide this service; the funding and staffing implications of same; and if he will make a statement on the matter. [15558/18]

Amharc ar fhreagra

Éamon Ó Cuív

Ceist:

769. Deputy Éamon Ó Cuív asked the Minister for Health the estimated increase in the number of abortions that will take place here if the Bill on terminations of pregnancy, the outline of which he published recently, in conjunction with the proposal to replace the 8th Amendment is passed; if these will take place in registered maternity hospitals or in specially provided facilities; if he has met with all the representative bodies of obstetricians and gynaecologists, midwives and other staff who will be involved in such procedures to discuss the implications of this proposed legislation; the examination that has taken place on this proposal with regard to staffing and financial implications; if the impact of this proposal on other services in maternity hospitals has been examined; if so, the conclusions of this examination; if a regulatory impact analysis of the proposal has been carried out; and if he will make a statement on the matter. [15559/18]

Amharc ar fhreagra

Éamon Ó Cuív

Ceist:

770. Deputy Éamon Ó Cuív asked the Minister for Health if his Department has examined the jurisdictions around the world that provide a general practitioner led abortion service in early pregnancy; if so, the names of these jurisdictions; the conclusions of such an examination in respect of the cost and staffing implications of same; the number of practices in each jurisdiction that provide the service as a proportion of the total number of general practitioner practices; if there is a regional disparity in these jurisdictions in the availability of the service; if an ultrasound examination is mandatory in all or some jurisdictions; and if he will make a statement on the matter. [15560/18]

Amharc ar fhreagra

Freagraí scríofa

I propose to take Questions Nos. 768 to 770, inclusive, together.

The Thirty-sixth Amendment of the Constitution Bill 2018 completed all stages in the Houses of the Oireachtas on Wednesday 28th March 2018.

The Minister for Housing Planning and Local Government has made a Polling Day Order for a referendum to be held on Friday 25th May 2018.

On Polling Day, the people will be asked to vote on whether they agree or disagree with the proposal to delete Article 40.3.3 in its entirety, and to substitute an article in the Constitution, the object and effect of which would be to articulate clearly the principle that laws may be enacted by the Oireachtas to provide for the regulation of termination of pregnancy.

In the event that the proposed Referendum on Article 40.3.3 is passed by the people, the Government would seek to give effect to legislation regulating the termination of pregnancy in Ireland. In such circumstances, the Department of Health would, in considering any such legislation, consult with representative bodies of all relevant medical practitioners on the details of the legislative proposals and possible service implications, as is the usually the case in developing legislation.

Liostaí Feithimh Ospidéal

Ceisteanna (771)

Peadar Tóibín

Ceist:

771. D'fhiafraigh Deputy Peadar Tóibín den Aire Sláinte cad é an t-am feithimh le haghaidh coinne ag clinic cluas, sróine agus scornaí na n-othar seachtrach in Ospidéal an Mater. [15576/18]

Amharc ar fhreagra

Freagraí scríofa

Maidir leis an gceist áirithe curtha, ó tharla gur ábhar seirbhíse atá i gceist, tá iarrtha agam ar an FSS freagra a sheoladh to díreach go dtí an Teachta. 

Hospital Waiting Lists

Ceisteanna (772)

Robert Troy

Ceist:

772. Deputy Robert Troy asked the Minister for Health if treatment will be provided for a person (details supplied); and if he will make a statement on the matter. [15578/18]

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 Waiting Lists

Ceisteanna (773)

Michael Healy-Rae

Ceist:

773. Deputy Michael Healy-Rae asked the Minister for Health the status of an operation for a person (details supplied); and if he will make a statement on the matter. [15579/18]

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 Facilities

Ceisteanna (774)

John McGuinness

Ceist:

774. Deputy John McGuinness asked the Minister for Health if his Department or the HSE has received an application to provide a modular catheterisation laboratory at University Hospital Waterford; his plans to provide funding for such a facility while a decision is being made on a permanent solution; the timeframe for a decision; and if he will make a statement on the matter. [15584/18]

Amharc ar fhreagra

Freagraí scríofa

Following an independent review of the need for a second cath lab in University Hospital Waterford (UHW), the Herity report concluded that the needs of the effective catchment population for Waterford University Hospital could be accommodated within a single cath lab. Funding has been provided to support extension of the existing cath lab operating hours to 12 weekly sessions per week, or by 20%, as recommended in the Herity Report. Recruitment efforts to support this service extension are ongoing.

A mobile cath lab was deployed in October 2017 for an initial period of 20 weeks and this was extended in February for another 10 weeks to allow further time for the recruitment effort. A modular cath lab has also been proposed, as an interim solution pending the outcome of the National Review of Specialist Cardiac Services, and my Department is currently examining this proposal.

The aim of the National Review of Specialist Cardiac Services is to achieve optimal patient outcomes at population level with particular emphasis on the safety, quality and sustainability of the services that patients receive by establishing the need for an optimal configuration of a national adult cardiac service. In terms of scope, the National Review will cover scheduled and unscheduled hospital-based services for the diagnosis and treatment of cardiac disease in adults.  The Steering Group for the review held its first meeting on 31 January last.

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