Written Answers Nos. 352-371
352. Deputy Caoimhghín Ó Caoláin asked the Minister for Health the amount of expenditure allocated in budget 2019 for personal assistant services to enable persons with disabilities to live independent lives. [53725/18]
Amharc ar fhreagraAs the HSE's National Service Plan for 2019 has not yet been finalised, a final decision with regard to the quantum of personal assistance hours to be delivered has not yet concluded, but will be agreed shortly.
It is the policy of the HSE to provide Personal Assistant services that are person-centred, equitable and transparent to people with a physical and/or sensory disability. The HSE is committed to protecting the level of Personal Assistant services and Home Support services available to persons with disabilities.
In 2018 the HSE's priority is to provide 1.46 million hours of personal assistance to almost 2,500 people, representing an increase of 60,000 hours over the 2017 target, and having regard to Home Support services will provide 2.93 million hours to both adults and children with a disability this year, an increase of 180,000 hours over the target for 2017. Since 2013 the number personal assistance hours has increased by 17% to the end of 2017.
353. Deputy Caoimhghín Ó Caoláin asked the Minister for Health his plans to introduce a standard assessment of need for persons with disabilities to access the personal assistance service across all HSE CHO areas; and if such a standard system will include support for independent assessments of need as per the Disability Act 2005. [53726/18]
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.
354. Deputy Caoimhghín Ó Caoláin asked the Minister for Health the work carried out on a cross-departmental basis in co-operation with the HSE to create a system that will allow for portability of personal assistance services across CHO areas that can meet the social, personal and employment needs of disabled persons without bureaucratic barriers. [53727/18]
Amharc ar fhreagraThe HSE is funded to provide personal assistance hours to provide personal and social services to people with disabilities. The provision of personal assistance supports for employment would be a matter for the Department of Employment Affairs and Social Protection.
As the Deputy's question regarding portability of PA hours between CHO areas 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.
355. Deputy Caoimhghín Ó Caoláin asked the Minister for Health the systems to be put in place to ensure that the attention of persons with disabilities is drawn to the availability of the personal assistant service in order that they can seek to lead independent lives and access the necessary supports to allow them to do so. [53728/18]
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.
356. Deputy Martin Heydon asked the Minister for Health the status of the progress of the assisted human reproduction Bill 2017; and if he will make a statement on the matter. [53730/18]
Amharc ar fhreagraAs you will be aware, the Government approved the drafting of a Bill on assisted human reproduction (AHR) and associated areas of research in October last year. The General Scheme is published on my Department’s website. This comprehensive piece of legislation encompasses the regulation of a range of practices, including: gamete (sperm or egg) and embryo donation for AHR and research; surrogacy; pre-implantation genetic diagnosis (PGD) of embryos; posthumous assisted reproduction; and embryo and stem cell research. The General Scheme also provides for an independent regulatory authority for AHR.
The Joint Committee on Health is currently conducting a review of the General Scheme of the Assisted Human Reproduction Bill 2017 as part of the pre-legislative scrutiny process, which began in January of this year. The review is on-going, and the Committee intends to publish its report early in 2019. The introduction of legislation in relation to AHR and associated research is a priority for me and the process of drafting this Bill will be completed in conjunction with the Office of the Attorney General. As part of this process officials in my Department will ensure that there is coherent interaction between the AHR Bill and Parts 2 & 3 of the Children and Family Relationships Act 2015. However, it is not possible at this time to give a definitive timeline for the completion of the draft Bill and its subsequent passage through the Houses of the Oireachtas.
357. Deputy Martin Heydon asked the Minister for Health the status of the progress of plans to introduce an opt-in system for organ donation; and if he will make a statement on the matter. [53731/18]
Amharc ar fhreagraThe General Scheme of a Human Tissue (Transplantation, Post-Mortem, Anatomical Examination and Public Display) Bill is being finalised at present and will be submitted to Government shortly.
The proposed legislation will include provisions for a soft opt-out organ donation system.
358. Deputy Stephen S. Donnelly asked the Minister for Health the status of the planned publication date of the new national oral health policy; and if he will make a statement on the matter. [53732/18]
Amharc ar fhreagraThe new National Oral Health Policy is currently being finalised and I expect it will be published early in 2019. The aim of the policy is to develop a model of care that will enable preventative approaches to be prioritised, improve access, and support interventions appropriate to current and future oral health needs.
359. Deputy Stephen S. Donnelly asked the Minister for Health the estimated cost of providing free dental care for children aged six, seven and eight years of age; and if he will make a statement on the matter. [53733/18]
Amharc ar fhreagraA targeted fissure sealant programme is provided for children usually in 2nd and 6th class in primary school (when children are generally aged between 6 to 8 and 11 to 13 years of age). In addition, a screening programme is provided for these same classes (age groups) with necessary interventions for permanent teeth including fillings and extractions. Treatment of pain and emergency treatment is provided to children up to 16 years of age. The services are provided by the Public Dental Service of the HSE which has a budget of approximately €70m to cover services for children and people with special needs.
The cost of providing any additional dental care to children would depend on a number of factors, including the underlying oral health of the population group, what such a service would include and how it would be provided. Future service provision will be informed by the National Oral Health Policy, which will be published early in 2019.
360. Deputy Michael Healy-Rae asked the Minister for Health if a hospital appointment will be expedited for a person (details supplied); and if he will make a statement on the matter. [53779/18]
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, since 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.
361. Deputy Michael Healy-Rae asked the Minister for Health the status of orthopaedic footwear for a person (details supplied); and if he will make a statement on the matter. [53783/18]
Amharc ar fhreagraAs this is a service matter it has been referred to the HSE for direct reply to the Deputy.
362. Deputy Michael Healy-Rae asked the Minister for Health the status of a hospital appointment for a person (details supplied); and if he will make a statement on the matter. [53820/18]
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, since 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.
363. Deputy Louise O'Reilly asked the Minister for Health the estimated cost of delivering general practitioner care for those cohorts that are entitled to free general practitioner care, that is, medical card holders, general practitioner visit card holders, persons over 75 years of age, children and so on; and if he will make a statement on the matter. [53823/18]
Amharc ar fhreagraGPs contracted under the GMS scheme to provide services to medical card and GP visit card holders receive a range of capitation payments, fee per service payments and practice supports. In 2017, the total amount paid to GPs under the GMS scheme amounted to approximately €525 million.
364. Deputy Louise O'Reilly asked the Minister for Health the number of persons directly employed by the HSE to provide home support services. [53824/18]
Amharc ar fhreagra365. Deputy Louise O'Reilly asked the Minister for Health the estimated cost of employing ten directly employed home care workers to provide home support services. [53825/18]
Amharc ar fhreagraI propose to take Questions Nos. 364 and 365 together.
As these are service matters I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.
366. Deputy Louise O'Reilly asked the Minister for Health the timeframe and cost per year of full implementation of the e-health system. [53826/18]
Amharc ar fhreagraI assume that the Deputy is referring to the planned capital provision to support the implementation of eHealth. Additional investment in eHealth and ICT for the period 2018-2021 was secured by my Department as part of the Mid-Term Capital Review and supported through the National Development Plan. The capital provision for eHealth and ICT for 2018 to 2021 is set out below and will allow for a multi-annual rolling programme of work on multiple projects:
|
2018 |
2019 |
2020 |
2021 |
|
€60m |
€85m |
€100m |
€120m |
The planned Capital provision will fund a large range of projects that support my Departments eHealth strategy as well as the HSE Knowledge & Information Plan as part of a rolling annual programme of work. The planned funding is for important systems such as the Electronic Health Record, the National Financial Management System, Individual Health Identifier, the Maternal and Newborn Information System and others.
A significant portion of the capital provided for ICT each year is required simply to replace and upgrade the existing ICT infrastructure and systems already deployed and necessary to support patient care and an organisations the size of the HSE. The balance of capital is allocated to the development and implementation of projects. Whilst the majority of these projects are for eHealth, there are also others e.g. corporate systems, that also need to funded from the same capital envelope.
Full development and implementation of the eHealth strategy will be over many years on a rolling basis with programme reviews, cost planning and annual expenditure commitments being made accordingly. It will ensure that Ireland can benefit from the potential of ICT and eHealth to improve health and wellbeing through improved efficiencies and the effectiveness of its health delivery services.
367. Deputy Louise O'Reilly asked the Minister for Health the amount the health service spent on end of life and palliative care in each of the years 2016, 2017 and to date in 2018, in tabular form; and if he will make a statement on the matter. [53827/18]
Amharc ar fhreagraAs this is a service matter I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.
368. Deputy Louise O'Reilly asked the Minister for Health the amount the health service spent on care for children with life-limiting conditions in each of the years 2016, 2017 and to date in 2018, in tabular form; and if he will make a statement on the matter. [53828/18]
Amharc ar fhreagraAs this is a service matter I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.
369. Deputy Louise O'Reilly asked the Minister for Health the estimated cost of purchasing and staffing one air ambulance to run 24-7, 365 days a year. [53829/18]
Amharc ar fhreagraAs this is a service issue, I have asked the HSE to reply to you directly.
370. Deputy Ruth Coppinger asked the Minister for Health if the prohibition of the use of vaginal mesh will be upheld; and if he will make a statement on the matter. [53849/18]
Amharc ar fhreagra371. Deputy Ruth Coppinger asked the Minister for Health the assistance that will be given to those seeking to have vaginal mesh removed; and if he will make a statement on the matter. [53850/18]
Amharc ar fhreagraI propose to take Questions Nos. 370 and 371 together.
In late 2017, concerns were brought to my attention about the frequency and severity of complications associated with the use of mesh devices in the surgical treatment of Stress Urinary Incontinence (SUI) and Pelvic Organ Prolapse (POP) in women in Ireland; the regulation and audit of their use; the extent of use of these devices in Ireland and the availability of services for women affected by mesh-associated complications, including through the tabling of several Parliamentary Questions.
In responding to these questions and in recognition of the complexity of the matters arising, I requested the Chief Medical Officer (CMO) to prepare a report for me on the clinical and technical issues involved in ensuring both:
a) the safe and effective provision of mesh procedures in urogynaecology; and
b) an appropriate response to women who suffer complications as a result of undergoing such procedures.
The Report, entitled The Use of Uro-gynaecological Mesh in Surgical Procedures, has now been presented to me and was published on the 21 November 2018 on the Department of Health website.
The report provides a brief background description of mesh implant devices, including the complications associated with their use; and summarises international best practice in the use of mesh procedures in the clinical management of SUI and POP. A range of recommendations for action by the HSE in collaboration with other stakeholders is identified, to provide assurance that the use of mesh implants and the care of women requiring aftercare in Irish hospitals is in line with emerging evidence and best practice internationally, based on expert advice received and review of international experience.
Methodology:
Preparation of the report has involved consultation and engagement with national and international bodies, including the Health Products Regulatory Agency (HPRA); the relevant professional training bodies, the Institute of Obstetricians and Gynaecology (IOG) and the Royal College of Surgeons in Ireland (RCSI); the Continence Foundation of Ireland (CFI) and the Health Service Executive (HSE), as well as colleagues in other jurisdictions. The report has been informed by review of international reports and safety reviews of mesh surgery which have been published in recent years. The report has also been informed by the personal experiences of women who have suffered complications following mesh surgery.
I wish to acknowledge the bravery, commitment and dignity shown, by the women that met with me and by those women who have written to me concerning this issue, in sharing what were harrowing, deeply personal experiences.
It is important to note that the views of the many women who have undergone mesh procedures and have had satisfactory outcomes, with minor or no complications, have not been formally sought and so are not reflected in this report. Also, following the implementation of a pause in mesh procedures by the HSE in July 2018, as described in Section 2, a number of women whose procedures were postponed made representations to the Department expressing concern at the impact that this has on them personally as they await treatment for the distressing symptoms of SUI, reflecting another important group of women affected directly by this issue.
Report Findings:
The report makes a number of overall findings, in addition findings are presented which relate to informed consent, aftercare of women with complications, clinical and professional issues and information issues. The findings are:
Overall Findings:
Mesh implant devices are certified as compliant with relevant European Union (EU) legislation and no market action against mesh devices for the treatment of SUI or POP has been taken by any of the European device regulatory competent authorities.
There is an extensive evidence base supporting (i) the use of the mid-urethral sling (MUS) devices in the treatment of SUI and (ii) the use of abdominally placed mesh in the management of POP. A significant majority of patients benefit greatly from these procedures, with reduced long-term complications and improved functional outcomes compared to non-mesh procedures.
Mesh procedures should be performed by trained personnel, in patients who are appropriately selected and counselled and when appropriate multidisciplinary expertise and clinical governance mechanisms are in place.
Transvaginal placement of mesh for the treatment of POP is no longer regarded as appropriate first line treatment. Its use is restricted by clinical guidance in some jurisdictions. Regulatory restrictions on its use are in place in Australia and New Zealand.
Mesh devices are associated with significant and severe complications in a minority of women, which are of concern given the difficulties of mesh implant removal.
Many other health systems, including the United Kingdom (UK), Australia and the Netherlands have implemented specific measures in recent years to ensure appropriate use of mesh procedures in the treatment of SUI and POP and to ensure appropriate aftercare for women suffering mesh complications.
Informed Consent:
As would be usual with many surgical conditions, standardised information resources were not available at national level to ensure that all patients receive consistent information about the benefits and risks of mesh devices, to advise of other treatment options and to support informed consent processes.
Many women reported that they were not informed of other treatment options; they had not been informed that their surgeries involved the use of mesh; they were not informed of mesh complications; and they were not made aware of the difficulties associated with mesh removal or with the treatment of long-term mesh complications.
Aftercare of Women with Complications
Structured treatment or referral pathways were not evidently in place for the minority of women requiring specialist, multidisciplinary care for serious complications following mesh surgery.
Some women reported considerable difficulty in accessing timely, compassionate and appropriate specialist aftercare for complications.
Some women reported that individual clinicians responded to their personal concerns in an inappropriate manner which greatly added to their distress. Women also reported feeling that they were not believed, or that their clinicians minimised or did not understand the severity of their complications.
Clinical and Professional Issues
Governance mechanisms are not in place at national level to provide assurance that mesh surgeries are carried out in accordance with agreed international best practice and clinical guidance.
There is no mandated professional clinical guidance at national level to guide the use of mesh implants in the management of SUI or POP or to guide the management of women with complications.
Communication mechanisms currently in place at national level between the HPRA, healthcare providers and professional bodies do not provide assurance that the findings and recommendations of safety reviews such as those circulated by the HPRA in recent years regarding mesh implants are systematically analysed and acted upon where appropriate.
Information
There are significant gaps in knowledge about current practice in Ireland regarding the use of urogynaecological mesh implants.
Routinely collected clinical information at national level does not provide the capacity for monitoring or audit of mesh surgeries for the treatment of SUI and POP.
Based on international experience, there is under-reporting of adverse events relating to mesh surgeries by clinicians to both the HPRA and to the National Incident Management System (NIMS) operated by the State Claims Agency (SCA).
Recommendations
Nineteen recommendations in total are identified throughout the report in response to the findings above:
Patient Information and Consent – 2 recommendations
Aftercare for Women Suffering Complications – 5 recommendations
Clinical and Professional Recommendations – 8 recommendations
Information Recommendations – 5 recommendations
These include recommendations about the development of patient information and informed consent materials to ensure appropriate patient selection and counselling, ensuring clinical and professional standards of practice are met by ensuring that all surgeons have undergone appropriate surgical professional training and ensuring that appropriate multidisciplinary expertise is available in units carrying out mesh procedures, the development of clinical guidance for the management of SUI and POP, the development of information resources to monitor the ongoing use of mesh devices and to permit long-term research and audit of practice, ensuring the reporting of mesh related complications, and ensuring timely, appropriate and accessible care pathways for the management of women with complications.
Full implementation of the report’s recommendations will provide significant assurance that all patients presenting for treatment for SUI and POP and all women who develop mesh-related complications receive high quality, patient centred care in accordance with accepted evidence and supported by robust clinical governance mechanisms.
Actions to date
A number of important interim system actions to address the safety and effectiveness of mesh implant use have been progressed in advance of completion of the report.
1. Pause on all uro-gynaecological mesh procedures
On July 24th, 2018, the HSE was requested by the CMO to pause all uro-gynaecological mesh procedures, in cases where it is clinically appropriate and safe to do so, pending confirmation by the HSE of the implementation of recommendations relating to (i) professional training requirements, (ii) patient information and consent and (iii) the development and maintenance of a national data set for all mesh procedures carried out in HSE funded hospitals. The request to institute a pause in vaginal mesh procedures was considered proportionate and necessary to address public and patient concern about the ongoing safety of mesh devices as comprehensively as possible.
2. Development of patient information and consent materials
Prior to this request, in May 2018, the HSE had been requested to begin work immediately on the development of national standardised patient information and informed consent materials and the clarification and development of treatment pathways and appropriate referral services for women suffering serious complications.
3. Learning Notice on mesh devices
A Learning Notice concerning mesh devices in uro-gynaecological procedures was circulated by the National Women and Infants’ Health Programme (NWIHP) on 26th June 2018 to all maternity hospitals and acute hospitals with gynaecological services to highlight the importance of appropriate patient selection, adequate information and consent and also to inform the service providers that a Response Group has been convened to propose remedies for and address the provision of aftercare for complications. This learning notice has been posted on the NWIHP website.
Acute Hospitals Division
4. Synthetic Mesh Devices Group
A Synthetic Mesh Devices Advisory Group has been convened by the NWIHP which includes three patient representatives, as well as representatives of the HPRA, the IOG, the RCSI, the CFI and all Hospital Groups, to advise on and progress all the interim recommendations as advised to the HSE in May 2018 and in July 2018. To ensure that the spectrum of views of women affected by mesh safety concerns is represented, the three patient representatives include Ms Melanie Power, representative of Mesh Survivors Ireland; as well as a woman who has had a successful outcome of mesh surgery for the treatment of SUI and a woman who is on the waiting list for surgery (currently paused).
I am informed that a work programme for the development of appropriate patient information resources and consent materials, the clarification and development of treatment pathways and appropriate referral services for women suffering from mesh-related complications including access to specialist diagnostic facilities such as translabial scanning is being progressed through this Group. The work being progressed by the HSE will include identifying the appropriate specialist clinical expertise and facilities required at hospital group level and nationally to provide comprehensive aftercare services. Pending the completion of this, the HSE will also examine the need to look at sourcing services from abroad to address any immediate shortfalls identified, either through utilisation of the treatment abroad scheme or by commissioning services from abroad.
Next Steps
As requested by the CMO in July 2018, the pause in the use of mesh procedures for the management of SUI and POP in HSE-funded hospitals is ongoing, in cases where it is clinically appropriate and safe to do so, pending confirmation by the HSE of the implementation of recommendations.
The Department of Health has written to the HSE to request that it prepare a detailed Implementation Plan for the complete set of recommendations set out in the CMO’s Report, working in conjunction with other stakeholders.
As promised at my meeting with Mesh Survivors Ireland on June 14th 2018, I provided the group with a copy of the CMO’s Report on the date of publication and a date will be arranged for a further meeting with the group in the near future.
