Written Answers Nos. 602-623
602. Deputy Thomas P. Broughan asked the Minister for Health if he has been informed by the HSE if it ensured that outsourced cervical screening tests had to be examined for a minimum amount of time; and if he will make a statement on the matter. [24389/18]
Amharc ar fhreagraAll laboratories contracted by CervicalCheck must operate in line with Quality Assurance standards and requirements set out by the cervical screening programme. Each laboratory is subject to ongoing monitoring by the programme to ensure compliance with QA standards.
Although there are no specific guidelines in relation to how long cytology screening staff should assess an individual sample, the current standard specifies that, in order to maintain quality, accuracy and safety in the screening process, the maximum time spent on primary screening LBC smear test samples must not be exceeded. This is set as 5 hours per day.
There is a maximum screening per annum of 12000 smears. Every test is examined by two screeners. All screeners (including supervisory screening staff) are expected to maintain their competence through participation in proficiency testing schemes, recognised cervical cytopathology External Quality Assurance schemes and in-house training, as appropriate.
The clinical advice is that there is no evidence that the clinical and technical aspects of the programme have performed outside or below international standards or the quality guidelines set for the programme. Smear tests can produce both false positive and false negative results. However, the Scoping Inquiry and the Independent Clinical Expert Review will provide independent and international scrutiny of performance.
603. Deputy Thomas P. Broughan asked the Minister for Health the steps he has taken over the past year to implement Sláintecare; his plans in this context for budget 2019; and if he will make a statement on the matter. [24390/18]
Amharc ar fhreagraThe Sláintecare Report represents a significant milestone in the history of our health services development in Ireland. I intend to harness the consensus generated by the Report to move forward with a programme of health reform. This Government is committed to making tangible improvements in our health service and the Sláintecare Report provides the direction of travel for this.
The development of a Sláintecare Implementation Plan is now well advanced and I expect to bring proposals to Government for consideration in the coming weeks. This plan will set out a detailed programme of reform to be undertaken in the years ahead.
I have already taken action on several of the specific recommendations proposed in the Sláintecare report. A Sláintecare Programme Office is being established in the Department of Health. This office will be tasked with implementing a programme of reform, as agreed by Government, arising from the Sláintecare Report. The appointment of an Executive Director for the Sláintecare Programme Office will be made shortly.
An independent board for the HSE is being established as recommended in the Sláintecare report. The General Scheme of a Bill has been published and it is hoped that legislation will be enacted this year.
The Sláintecare Report recommended the removal of private practice from public hospital. I have established an Independent Review Group to examine how private practice can be removed from public hospitals. It will report later this year.
A public consultation on the geographical alignment of Hospital Groups and Community Healthcare Organisations has recently been completed and will inform work on broader health service structural reform as recommended in the Sláintecare report.
Finally, the Government has demonstrated significant commitment to invest in our health and social care services since the publication of the Sláintecare report. Funding for new initiatives in Budget 2018 were closely aligned with proposals in Sláintecare. These new initiatives included investing €25 million a new Primary Care fund, additional funding of €25 million allocated for home care and transition beds, €17 million to reduce medicine and prescription charges, €75 million targeted to reduce waiting list and €1 million for the Sláintecare Programme Office.
The Health Service Capacity Review, which was called for in the Report, was published in January, and the recently published National Development Plan contains a commitment to fund significant new capacity – 2,600 acute hospital beds and 4,500 community care beds over the next decade. It also contains funding to deliver on the eHealth strategy in full which is a key recommendation in Sláintecare.
As the Deputy is aware, Budget 2019 will be subject to discussions with the Minister for Public Expenditure and Reform in the normal manner and I am not able to comment on specifics at this stage.
604. Deputy Charlie McConalogue asked the Minister for Health the status of the negotiations between his Department and the farming organisations with a view to introducing a cap on the number of years farmland can be calculated as an asset for the purposes of making contributions towards the fair deal scheme; his plans to reduce the number of years an asset must be transferred to a family member before it becomes ineligible as an asset for means; and if he will make a statement on the matter. [24392/18]
Amharc ar fhreagraA review of the Nursing Homes Support Scheme (NHSS) 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 also committed to reviewing the NHSS to remove any discrimination against small businesses and family farms.
At present, 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. This cap does not apply to productive assets such as farms and businesses except in cases of sudden illness or disability where specific conditions are met.
It is proposed to amend the scheme to treat farm and business assets in the same manner as the principal private residence where a family successor commits to working the farm or business, i.e. to cap contributions at three years.
The Department of Health has been examining the potential for changes to the treatment of business and farm assets under the Nursing Homes Support Scheme. The Department has had a number of engagements with the Irish Farmers Association (IFA) in this regard. Any changes to the scheme, if approved by Government, will require amendment of the Nursing Homes Support Scheme Act 2009.
A Memorandum for Government setting out the details of the proposed policy change and seeking Government approval to draft the General Scheme of a bill to amend the Nursing Homes Support Scheme Act 2009 has been circulated to other Government Departments for observations.
Currently an asset which has been transferred within 5 years prior to the date on which an application for State support is first made is considered a transferred asset and is included in the financial assessment under the Scheme. There are currently no plans to amend this provision.
605. Deputy Noel Rock asked the Minister for Health his plans to support myalgic encephalomyelitis patients and carers; if his Department will review the HSE’s handling of this condition; and if he will make a statement on the matter. [24401/18]
Amharc ar fhreagraAs this is a service issue this Parliamentary Question has been referred to the Health Service Executive for a direct reply.
606. Deputy Timmy Dooley asked the Minister for Health the status of surgery for a person (details supplied); and if he will make a statement on the matter. [24406/18]
Amharc ar fhreagraUnder 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.
607. Deputy David Cullinane asked the Minister for Health if it is policy to send children with autism spectrum disorder to the UK if no residential placement is available here or to place a child in an adult psychiatric ward as an interim measure; and if he will make a statement on the matter. [24409/18]
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.
608. Deputy Clare Daly asked the Minister for Health the strategy in place to provide services for school leavers and young persons who are exiting RT programmes in 2018. [24426/18]
Amharc ar fhreagra609. Deputy Clare Daly asked the Minister for Health the steps he is taking to develop a long-term strategy to put in place adequate services to meet the growing needs of those exiting disability and RT services on reaching 18 years of age. [24427/18]
Amharc ar fhreagraI propose to take Questions Nos. 608 and 609 together.
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.
HSE Disability Services engages in a detailed and person centred process with a wide range of agencies every year to identify the most appropriate service provider and quantum of service and to meet the individual needs of each school leaver. This process takes place over a number of months and is led by the needs of each individual school leaver. In addition, HSE Disability Services also engages with individual school leaver families to listen to, and address, any concerns they may have regarding the process. Funding of €12.5 million has been allocated to fund day services for school leavers and people leaving rehabilitative training this year.
As the Deputy's questions relate to service matters, I have arranged for the questions to be referred to the Health Service Executive (HSE) for direct reply to the Deputy.
610. Deputy Catherine Murphy asked the Minister for Health if his attention has been drawn to a submission by a group (details supplied) regarding the HSE’s implementation from 30 April 2018 of the standard operating procedure for the assessment of need; and if he will make a statement on the matter. [24434/18]
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.
611. Deputy John Lahart asked the Minister for Health when a person (details supplied) will be supplied with medical supplies; and if he will make a statement on the matter. [24436/18]
Amharc ar fhreagraAs this is a service matter it has been referred to the HSE for direct reply to the Deputy.
612. Deputy Michael Harty asked the Minister for Health if he will address a matter (details supplied) regarding cataract waiting lists; and if he will make a statement on the matter. [24437/18]
Amharc ar fhreagraImproving waiting times for patients for hospital operations and procedures is a key priority for the Government.
Cataract surgery is among the most common surgical procedures carried out in the Ophthalmology specialty. Through the work of the National Treatment Purchase Fund (or NTPF) and the Health Service Executive (HSE), the overall number of patients waiting for cataract surgery has fallen by 22% since July 2017, while the number of patients waiting more than 12 months has declined by 71% in the same period. For 2018, under the Inpatient/Day Case Action Plan, all clinically suitable patients waiting for more than 9 months for a Cataract procedure will be offered treatment this year, with 5,000 NTPF funded procedures planned in both public and private hospitals.
Last year funding was allocated to provide additional capacity at the Royal Victoria Eye and Ear Hospital and as a result, a cataract theatre is now operational three days per week. This year, in line with the Action Plan, the HSE is planning to open a dedicated Cataract theatre in Nenagh Hospital in July.
613. Deputy Michael Healy-Rae asked the Minister for Health the difference between the fee for private and HSE run nursing homes (details supplied); and if he will make a statement on the matter. [24438/18]
Amharc ar fhreagraThe 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.
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 residents 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. 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. The Department will be working on this review throughout the year.
I have also asked the Interdepartmental Working Group established to oversee the implementation of the recommendations contained in the NHSS Review 2015 to examine the issue of additional charges, as part of its on-going work.
In the first instance a Department of Health/HSE project group was established to examine the high level issues regarding additional charges in nursing homes participating in the NHSS. The project work is underway and the team has written to a number of private/voluntary and public nursing homes with a view to arranging individual meetings to examine the matter. On foot of this initial engagement, visits to nursing homes are being scheduled and will be conducted over the coming weeks.
The implementation of any recommendations arising from this work will be developed with the input and support of relevant stakeholders from the sector.
614. Deputy Róisín Shortall asked the Minister for Health the waiting times for children to access speech and language therapy, psychological therapy and occupational therapy at Beechpark Services for children with autism spectrum disorder in north-west areas of County Dublin in tabular form; the steps he will take to address the waiting lists; and if he will make a statement on the matter. [24441/18]
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.
615. Deputy Róisín Shortall asked the Minister for Health further to Parliamentary Question No. 771 of 7 November 2017, the status of the PRAC's review of valproate; the response of the HPRA to the outcome of this review; the steps it will take to increase awareness of the potential side effects of this drug in pregnant women; the multidisciplinary team services that are available to children born with FACS; and if he will make a statement on the matter. [24443/18]
Amharc ar fhreagra675. Deputy Sean Fleming asked the Minister for Health his views on the prescribing of sodium valproate to treat epileptic disease and seizures in respect of women who are pregnant; and if he will make a statement on the matter. [24643/18]
Amharc ar fhreagraI propose to take Questions Nos. 615 and 675 together.
The European Medicines Agency’s Pharmacovigilance Risk Assessment Committee (PRAC) completed its review of sodium valproate in February 2018, and recommended new measures to avoid exposure of babies to valproate-containing medicines in the womb. These measures were subsequently endorsed by the Coordination Group for Mutual Recognition and Decentralised Procedures - Human (CMDh), a medicines regulatory body representing all EU and EEA member states. Because the CMDh position was agreed by majority vote, it was sent to the European Commission, which issued a final legally binding decision valid across the EU on 31 May.
The new measures include a ban on the use of valproate-containing medicines for migraine or bipolar disorder during pregnancy, and a ban on using such medicines to treat epilepsy during pregnancy unless there is no other effective treatment available.
In addition, these medicines must not be used in any woman or girl able to have children unless the conditions of a new pregnancy prevention programme are met. The programme is designed to ensure that patients taking valproate are fully aware of the risks and the need to avoid becoming pregnant while taking the drug.
The Health Products Regulatory Authority (HPRA) is working with national stakeholders, including patient representatives and healthcare professionals, to implement the new risk minimisation measures in Ireland, including materials developed to support safe prescribing and dispensing of valproate, and in particular to ensure that patients and carers are fully informed of the risks and can discuss options with their doctor.
Measures currently being updated in line with the new recommendations include:
- Changes to the product information for patients and healthcare professionals;
- A visual warning on the packaging of valproate medicines;
- Revised educational materials for patients and doctors; and
- A patient alert card to be attached to the product packaging
The HSE is working in partnership with relevant patient representatives and clinical experts to review the diagnostic and support services required by people who may have been affected by foetal anticonvulsant syndrome (FACS).
For women currently taking sodium valproate, which is marketed under the brand name Epilim in Ireland, the clear advice from the HPRA and the HSE is that they should not stop taking this medicine suddenly; instead they should get in touch with their doctor or pharmacist for further guidance.
616. Deputy Róisín Shortall asked the Minister for Health if his attention has been drawn to the concerns being raised by parents, schools and representative bodies of relevant allied professionals regarding the new HSE model for assessments of need which will not involve a diagnosis as part of the assessment process; the rationale behind these changes; and if he will make a statement on the matter. [24446/18]
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.
617. Deputy Niamh Smyth asked the Minister for Health if an appointment for a person (details supplied) will be expedited as a matter of urgency; and if he will make a statement on the matter. [24453/18]
Amharc ar fhreagraThe Deputy's question relates to service delivery matters and accordingly I have asked the HSE to respond directly to her.
618. Deputy Fergus O'Dowd asked the Minister for Health the position regarding each of the recommendations made in a report (details supplied) on a nursing home; and if he will make a statement on the matter. [24454/18]
Amharc ar fhreagraFollowing the publication of the report referred to by the Deputy the Health Service Executive established a working group in 2007 to coordinate and finalise all outstanding issues pertaining to the report.
The working group completed a comprehensive report in 2007 which indicated that action from the recommendations had been completed, or that work was ongoing to ensure compliance with the recommendations. The recommendations were superceded subsequently by the Commission of Investigation into the Management, Operation and Supervision of Leas Cross Nursing Home and by the Health Act 2007 which established the Health Information and Quality Authority. This provided for the registration and inspection of all nursing homes – public, private and voluntary. Independent inspections carried out by HIQA commenced on 1 July 2009. This system replaced the previous one, under which the HSE registered and inspected private nursing homes only. This responsibility is underpinned by a comprehensive quality framework comprising regulations and National Quality Standards.
The Health Act 2007 (Care and Welfare of Residents in Designated Centres for Older People) Regulations 2013, replaced the 2009 Care & Welfare Regulations. These regulations contain provisions for the purposes of ensuring proper standards of care for nursing homes and include health care planning, residents’ rights and protection from abuse. Operators must arrange comprehensive assessments of the health, personal and social care needs of residents and prepare and individualised care plan based on this assessment. The regulations also provide for training and staff development and include requirements for the management and control of operations of nursing homes.
Revised National Quality Standards were approved by the Minister for Health in 2016, placing a stronger focus on quality of life and a person-centred approach to the care of all residents.
The recently published overview of HIQA regulation of social care and healthcare services 2017 recognises that there remain some issues to be addressed, and the Authority will continue to focus on these key areas through its inspection programme. It acknowledged however that many nursing home providers go beyond basic compliance with the regulations and are striving to achieve quality improvement as set out in the National Standards.
Separate to the regulatory regime introduced in 2009 the Deputy will be aware that the Nursing Homes Support Scheme was also introduced that year to address the then inequity in the treatment of public and private long-term nursing home residents and to alleviate the financial hardship being experienced by long-term residents in private nursing homes. The scheme supports individuals in need of long-term nursing home care regardless of whether they choose public, private or voluntary nursing homes.
619. Deputy Mattie McGrath asked the Minister for Health if he has reviewed or plans to review the prohibition of euthanasia, assisted dying and physician assisted suicide; and if he will make a statement on the matter. [24455/18]
Amharc ar fhreagraIt is an offence, under section 2(2) of the Criminal Law (Suicide) Act 1993, to assist another person in taking his or her life. Legal provisions concerning euthanasia are a matter for the Department of Justice and Equality.
The Minister for Health has no plans to review the prohibition of euthanasia and related matters.
The Department of Health engages with the HSE and nongovernmental organisations to provide palliative care to people across Ireland. Palliative care seeks to improve quality of life through the prevention and relief of pain and suffering.
620. Deputy Mattie McGrath asked the Minister for Health the policy position with respect to medicinal cannabis; and if he will make a statement on the matter. [24456/18]
Amharc ar fhreagraCannabis is strictly controlled under the Misuse of Drugs Acts 1977 to 2016, and the Regulations and Orders made thereunder.
The two most common active components found in cannabis oil are tetrahydrocannabinol (THC) and cannabidiol (CBD).
- THC is the principal psychoactive constituent of cannabis. Under the Misuse of Drugs legislation products containing THC are strictly controlled and possession is unlawful except under licence.
- CBD is derived from cannabis. However, since it is not psychoactive it is not controlled under the Misuse of Drugs legislation, and does not require a Ministerial Licence.
Access to Medical Cannabis via the Ministerial Licence Route
- Currently medical practitioners who wish to prescribe cannabis products containing THC may apply to the Minister for Health, for a licence under the Misuse of Drugs Act.
- The Chief Medical Officer has advised that the granting of such a licence must be premised on an appropriate application being submitted to the Department of Health, which is endorsed by a consultant who is responsible for the management of the patient and who is prepared to monitor the effects of the treatment over time.
How to apply for a Ministerial licence
- A medical cannabis licence application submitted to the Minister for Health, in line with the Misuse of Drugs Acts, must include:
- An outline of the treatment the patient has received to date and justification from the doctor as to why it is appropriate in their patient’s specific circumstances to prescribe cannabis.
- Details of the cannabis product which it is proposed to prescribe and administer to the patient.
- The source of the cannabis product.
- The arrangements for the ongoing monitoring and care of the patient once the cannabis-based treatment has commenced.
The application must be submitted either by the patient’s medical consultant, or by their General Practitioner (GP). Applications from the patient's GP must include written endorsement for the proposed cannabis treatment for the individual patients by the patient's consultant.
The decision to prescribe or not prescribe any treatment, including cannabis treatment, for an individual patient is strictly a decision for the treating clinician, in consultation with their patient. The Minister for Health has no role in this clinical decision-making process.
Consultants or GPs requiring further information or clarification in relation to the licence application process are advised to contact the Department of Health directly. Valid applications received are assessed without delay.
Medicinal Cannabis Access Programme (under development)
The Minister for Health is in the process of establishing a ‘Cannabis for Medical Use Access Programme’ 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. The access programme will be established to provide access to cannabis treatments for patients who are under the care of a medical consultant, for the following medical conditions which have failed to respond to standard treatments:
- spasticity associated with multiple sclerosis resistant to all standard therapies and interventions;
- intractable nausea and vomiting associated with chemotherapy;
- severe, refractory (treatment-resistant) epilepsy that has failed to respond to standard anticonvulsant medications.
An Expert Group appointed by the Minister has drawn up clinical guidance for healthcare professionals treating patients through the Access Programme and Department of Health Officials are working on legislation to underpin the Access Programme. The access programme is not yet in operation.
In the meantime access to cannabis for medical treatment is via the aforementioned Ministerial licence application route, which will continue to operate in parallel to the Cannabis for Medical Use Access Programme, once the programme becomes operational.
621. Deputy Mattie McGrath asked the Minister for Health the status of the implementation of the Misuse of Drugs (Supervised Injecting Facilities) Act 2017; the costs to date associated with the operation and staffing of such supervised injecting facilities; and if he will make a statement on the matter. [24457/18]
Amharc ar fhreagraThe establishment of a pilot supervised injecting facility is a commitment in the Programme for a Partnership Government and is a key action in the national drugs strategy, Reducing Harm, Supporting Recovery. The purpose of the facility is to provide a clean, safe, healthcare environment where people who inject drugs can access medical and social services from healthcare professionals. The ultimate aim is to reduce the number of heroin-related deaths, of which there were 82 in 2015.
The legislative basis for the establishment of such a facility is set out in the Misuse of Drugs (Supervised Injecting Facilities) Act 2017 (No.7 of 2017), which came into operation on 30 November 2017.
The Department of Health allocated €1.5m to the HSE for the establishment of the pilot facility for 2018.
In February 2018, the HSE announced Merchants Quay Project CLG as the preferred bidder to operate a supervised injecting facility in Dublin city centre on a pilot basis. The awarding of the contract followed a HSE procurement process initiated in August 2017 and is subject to normal planning permission approval.
I understand that no resources for the facility have been allocated to Merchants Quay Project pending the awarding of planning permission from Dublin City Council.
I support the establishment of a supervised injecting facility as a public health initiative to save lives and to ensure safer communities. Evidence from countries with such facilities shows that they are cost-effective in the long-run, through reducing ill-health for injecting drug users and by improving the environment for residents and businesses. Engaging with local stakeholders, including schools, is therefore an important element of the set up and running of the facility.
622. Deputy Mattie McGrath asked the Minister for Health if he or his Department has raised the phenomenon of gendercide at national or international fora; and if he will make a statement on the matter. [24458/18]
Amharc ar fhreagraNo, neither I nor my Department have done so.
623. Deputy Mattie McGrath asked the Minister for Health the number of meetings or engagements he and his Department have had with organisations (details supplied) in the past three years; and if he will make a statement on the matter. [24459/18]
Amharc ar fhreagraSince my appointment as Minister for Health I have attended a photocall on 14 July 2016 and a campaign event earlier this year on 10 April with Amnesty International.
No Departmental staff were present at these events.
