Thursday, 19 Apr 2018

Written Answers Nos. 258-268

Medicinal Products Reimbursement

Ceisteanna (258)

Tony McLoughlin

Ceist:

258. Deputy Tony McLoughlin asked the Minister for Health his views on the fact that in 2018 it was announced that Pembrolizumab would be licensed in April 2018 for NSCLC patients however his Department and the HSE attached a narrow window of eligibility as it is a requirement that the tumour has a PD-L1 expression of over 50%; if this requirement can be reduced to bring it in line with similar drugs such as Nivolumab; and if he will make a statement on the matter. [17350/18]

Freagraí scríofa

Minister for Health

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.

Pembrolizumab is reimbursed for the following indications:

- KEYTRUDA as monotherapy is indicated for the treatment of advanced (unresectable or metastatic) melanoma in adults.

- KEYTRUDA as monotherapy is indicated for the first-line treatment of metastatic non-small cell lung carcinoma (NSCLC) in adults whose tumours express PD-L1 with a 50% tumour proportion score (TPS) with no EGFR or ALK positive tumour mutations.

I have been informed by the HSE that they are currently assessing the following indication for reimbursement:

- KEYTRUDA as monotherapy is indicated for the treatment of locally advanced or metastatic NSCLC in adults whose tumours express PD-L1 with a 1% TPS and who have received at least one prior chemotherapy regimen. Patients with EGFR or ALK positive tumour mutations should also have received targeted therapy before receiving KEYTRUDA.

The NCPE is currently conducting their HTA on this indication and the HSE will evaluate this application for reimbursement in line with the 2013 Act.

Emergency Departments

Ceisteanna (259)

Bernard Durkan

Ceist:

259. 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. [17351/18]

Freagraí scríofa

Minister for Health

Against a background of growing demand for unscheduled care and high acute hospital occupancy rates, Government provided €30 million in 2017 and a further €40 million in 2018 for measures to increase acute hospital capacity and alleviate overcrowding in Emergency Departments.  Almost 50% of this funding was used to deliver home support packages and transitional care beds to reduce the incidence of delayed discharges.  Furthermore, over 200 beds have been opened this winter and more beds are due to come on stream later in the year.

Notwithstanding the increased level of resources provided, this winter has been particularly difficult for our health services with ED attendances up 3.7% and admissions up 3.3% during the first quarter of the year, as compared to the same period in 2017.

The situation was further exacerbated by Storm Emma and the severe weather that followed.  In response to this, I approved a further €5m in emergency funding to provide additional home support packages and transitional care beds to assist the safe discharge of patients who required support to return home following the adverse weather.

In the light of the conclusions of the Health Service Capacity Review that the system will need nearly 2,600 additional acute hospital beds by 2031, I have asked my Department to work with the HSE to identify the location and mix of beds across the hospital system which can be opened and staffed this year and into 2019 in order to improve preparedness for Winter 2018/2019.

As outlined in the Capacity Review, the demographic pressures being experienced by the health service are such as to demand not just additional capacity but continued emphasis on health and wellbeing initiatives, an improved model of care with a stronger role for enhanced community based services and continued improvement in productivity including in acute hospitals.  The Government has approved a record level of capital investment in health at €10.9 billion over the next ten years.  This will provide for a major enhancement of the capacity of our health services to meet demand.  Importantly, the accelerated introduction of additional capacity for 2018/2019 will be matched by forthcoming reforms including the publication of a detailed Sláintecare Implementation Plan and the overhaul of the current GP contract.

Finally, a review of the Winter Initiative 2017/2018 is being undertaken, which will inform a 3 year plan for unscheduled care, as well as supporting the provision of additional capacity in Winter 2018/19.

Mental Health Services Data

Ceisteanna (260)

Bernard Durkan

Ceist:

260. Deputy Bernard J. Durkan asked the Minister for Health the extent to which speech and language therapy and mental health support exists for children in all areas throughout the country; if particular shortfalls have been identified and are being addressed; and if he will make a statement on the matter. [17352/18]

Freagraí scríofa

Minister for Health

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.

Health Services Reform

Ceisteanna (261)

Bernard Durkan

Ceist:

261. Deputy Bernard J. Durkan asked the Minister for Health when a restructuring of the HSE will take place with a view to greater accountability and influence at regional level including representational status for professionals and public representatives; and if he will make a statement on the matter. [17353/18]

Freagraí scríofa

Minister for Health

The Committee on the Future of Healthcare published its report, Sláintecare, last year. This report makes a number of recommendations in relation to improving governance and accountability in the health service, including the establishment of a governing board for the HSE and the establishment of regional bodies to support the delivery of integrated care.

As the Deputy is aware, a range of actions are already being taken in response to the Sláintecare report. Work is at an advanced stage in my Department in developing a Sláintecare Implementation Plan. The plan will translate the Sláintecare Report into a detailed programme of reform over the next 10 years, with a focus on the immediate years ahead. I have already signalled my support for the Committee's recommendations in relation to governance and accountability and these will form an integral component of the Implementation Plan. I expect to bring this Plan to Government shortly.

The Government has also agreed to the establishment of a governing board for the HSE. Preparatory work is underway and I will bring a Memorandum to Government with a draft General Scheme of a Bill in the coming weeks. My Department has also recently opened a public consultation regarding the geo-alignment of Hospital Groups and Community Healthcare Organisations. These actions are important elements of overall proposals in relation to governance and accountability in the health service.

Transport Support Scheme

Ceisteanna (262)

Bernard Durkan

Ceist:

262. Deputy Bernard J. Durkan asked the Minister for Health the progress to date in determining the appropriate scheme to replace the mobility allowance and motorised transport grant; and if he will make a statement on the matter. [17354/18]

Freagraí scríofa

Minister of State at the Department of Health

The Deputy will be familiar with the background to the closure of both the Mobility Allowance and Motorised Transport Grant schemes in February 2013. Since the closure of the Mobility Allowance, the Government has directed that the Health Service Executive should continue to pay an equivalent monthly payment of up to €208.50 per month to the 4,133 people in receipt of the Mobility Allowance, on an interim basis, pending the establishment of a new Transport Support Scheme.

The Government decided that the detailed preparatory work required for a new Transport Support Scheme and associated statutory provisions should be progressed by the Minister for Health.  The Programme for a Partnership Government acknowledges the ongoing drafting of primary legislation for a new Transport Support Scheme to assist those with a disability to meet their mobility costs. The Health (Transport Support) Bill is on the list of priority legislation for publication in the Spring/Summer session 2018. I can confirm that work on the policy proposals for the new Scheme is at an advanced stage. The proposals seek to ensure that:

- There is a firm statutory basis to the Scheme's operation;

- There is transparency and equity in the eligibility criteria attaching to the Scheme;

- Resources are targeted at those with greatest needs; and

- The Scheme is capable of being costed and is affordable on its introduction and on an ongoing basis.

It is hoped to bring a General Scheme and Heads of Bill to Government shortly, seeking Government approval to the drafting of the Bill for the new Transport Support Payment.

With regard to the Motorised Transport Grant, this scheme operated as a means-tested grant to assist persons with severe disabilities with the purchase or adaptation of a car, where that car was essential to retain employment. The maximum Motorised Transport Grant, which was payable once in any three-year period, was €5,020.  Following closure of the scheme in February 2013,  no further Motorised Transport Grants have been payable.

It is important to note that the Disabled Drivers and Disabled Passengers scheme operated by the Revenue Commissioners, remains in place. This scheme provides VRT and VAT relief, an exemption from road tax and a fuel grant to drivers and passengers with a disability, who qualify under the relevant criteria set out in governing regulations made by the Minister for Finance.  Specifically adapted vehicles driven by disabled persons are also exempt from payment of tolls on national toll roads and toll bridges. Transport Infrastructure Ireland has responsibility for this particular Scheme.

There are improvements in access to a range of transport support schemes available to persons with disabilities in the State and on-going work is being carried out by Government Departments, agencies and transport providers to further improve access to public transport services. Under the National Disability Inclusion Strategy, the Department of Transport, Tourism and Sport has responsibility for the continued development of accessibility and availability of public transport for people with a disability.

Health Services Staff Data

Ceisteanna (263)

Bernard Durkan

Ceist:

263. Deputy Bernard J. Durkan asked the Minister for Health the staffing levels throughout the public health sector at all levels in hospitals and community care; the extent to which they have been augmented in recent years; and if he will make a statement on the matter. [17355/18]

Freagraí scríofa

Minister for Health

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

Hospital Waiting Lists

Ceisteanna (264, 265, 268)

Bernard Durkan

Ceist:

264. Deputy Bernard J. Durkan asked the Minister for Health if the National Treatment Purchase Fund can be utilised to alleviate waiting lists at public hospitals; and if he will make a statement on the matter. [17356/18]

Bernard Durkan

Ceist:

265. Deputy Bernard J. Durkan asked the Minister for Health the extent to which he is monitoring the waiting lists throughout the health service with particular reference to specific procedures such as miscellaneous orthopaedic, cardiac, neurological or other procedures; if the utilisation of the treatment purchase scheme can be used to clear backlogs to facilitate efficiencies throughout the service; and if he will make a statement on the matter. [17357/18]

Bernard Durkan

Ceist:

268. Deputy Bernard J. Durkan asked the Minister for Health the extent to which the treatment purchase scheme is being used to address issues of delays experienced by persons awaiting various procedures; and if he will make a statement on the matter. [17360/18]

Freagraí scríofa

Minister for Health

I propose to take Questions Nos. 264, 265 and 268 together.

The National Treatment Purchase Fund (NTPF) has a statutory role to collect, collate and validate information in relation to persons waiting for hospital treatment and to put in place information systems and procedures for that purpose.

The NTPF is under the governance (aegis) of the Department of Health and my Department has a governance structure in place which involves regular governance and monitoring meetings with both the NTPF and HSE, including at Ministerial level.

The Inpatient/Day Case Action Plan, published on 12 April, is a joint initiative between the HSE, the NTPF and my Department and sets the projected activity and impact that will be delivered in 2018 from within the allocated funding. As outlined in the Action Plan, a projected 1.16 million inpatient and day case procedures will take place in 2018, with NTPF activity accounting for 20,000 procedures and HSE activity 1.14 million procedures.

The NTPF procures capacity for each of the procedures identified in the Action Plan in both private hospitals or public hospitals. The NTPF will target seven procedures which account for 40% of people on the Active Inpatient Day Case waiting list:

Cataracts, Hip/Knee replacements, Varicose Veins, Tonsillectomies, Cystoscopies, Coronary Angiograms, and Excision of Lesions, amounting to 13,800 procedures, as well as 5,000 procedures across an expanded range of over 40 other procedures, and 4,000 GI Scopes.

The Action Plan strikes the appropriate balance between maximising the number of patients treated in both public and private capacity, as appropriate, and ensuring the best return for the taxpayer.

The overall number of patients waiting for an inpatient or day case procedure is projected to fall to below 70,000 by year end, from a peak of 86,100 in July 2017. My ambition is to build upon this progress in 2019 and to further reduce waiting times for Irish patients.

General Practitioner Data

Ceisteanna (266)

Bernard Durkan

Ceist:

266. Deputy Bernard J. Durkan asked the Minister for Health the number of general practitioners practising here; the extent to which this number has fluctuated in the past ten years; the extent to which demographic trends are affecting requirements in this area; and if he will make a statement on the matter. [17358/18]

Freagraí scríofa

Minister for Health

General Practitioners play an important role in the primary care system.  The number of General Practitioners on the specialist register continues to increase – up from 2,270 in 2010 to 3,637 at the end of 2017 and the number of GPs contracted by the HSE under the GMS scheme has also risen from 2,098 in 2008 to 2,485 as of 1 April 2018.

The 2018 Health Service Capacity Review proposes a number of estimates of between 4,790 and 4,970 General Practitioners that may be required by 2031.  While it is important to note that these estimates are based on statistical models of demand and are subject to certain assumptions, the Government is aware of the manpower issues facing general practice and has taken steps to increase the numbers of General Practice training places accordingly.

In 2009, there were 120 General Practice training places available and this year it is expected that over 190 training places will be filled, an increase of around 60% over a nine year period. The number of training places will rise to 259 in coming years. There were over 400 applications for the 2018 training programme which is a significant increase of almost 50% on the number of applications from 2017.

The Government is also committed to engaging with General Practitioner representatives on necessary service improvements and contractual reforms to the current GMS contract.  This process is expected to commence in the coming weeks. The primary focus of the consultations will be on a package of measures and reforms which, if agreed, will result in an expansion in the scope of the service provided by General Practitioners to holders of medical and visit cards.

There is potential for State expenditure on General Practitioner services to increase significantly in coming years if the talks are successful. However, any revision of fees is contingent upon health contractors agreeing to the delivery of necessary service improvements and contractual reforms in line with the Government’s priorities for the health service.

Medicinal Products Prices

Ceisteanna (267)

Bernard Durkan

Ceist:

267. Deputy Bernard J. Durkan asked the Minister for Health if particular medicines are to be included in the discussions to reduce the cost with particular reference to innovative medicines and or generic medicines; if legislative changes are planned in this context; and if he will make a statement on the matter. [17359/18]

Freagraí scríofa

Minister for Health

Officials in my Department have sought further clarification from the Deputy in relation to this PQ. 

Question No. 268 answered with Question No. 264.