Written Answers Nos. 389-408
389. Deputy Pearse Doherty asked the Minister for Health when all beds housed within the short-stay ward at Letterkenny University Hospital will be operational; the number of additional personnel that have been allocated to the service and unit for 2019; the job titles of posts that have been allocated; and if he will make a statement on the matter. [2522/19]
Amharc ar fhreagraAs Minister for Health, I recognise that hospitals are increasingly operating at or above capacity, with year-round demand pressures that are further challenged over the winter months. It is against this background that the Health Service Capacity Review 2018 recommended an increase in acute hospitals beds of over 2,600 by 2031 to support the projected increase in demand for services in the years ahead.
Increasing capacity is therefore a priority for the Government. Over the past 12 months, an additional 240 beds have been opened.
A Capacity Programme for 2019 has been agreed which provides for the following increases to capacity, as set out in the National Service Plan 2019
- 78 additional beds are planned for Quarter 1 of 2019, including the 40 bed modular build in South Tipperary General Hospital and the 30-bed ward in Our Lady of Lourdes Hospital Drogheda;
- 75 acute beds and 70 community beds to come on stream in 2019, as part of the Winter Plan 2018/19, including 5 additional beds in Letterkenny University Hospital due for opening in quarter 1 2019;
- preparation of 202 beds, of which 16 are critical care, by quarter 4 2019 with a view to bringing this extra capacity into operation in the first quarter of 2020, including additional beds in Letterkenny University Hospital.
In relation to the Deputy's query on when the beds will be operational, the number of additional personnel and the job titles of posts that have been allocated for 2019, as this is a service matter, I have asked the HSE to reply to the Deputy directly.
390. Deputy Mattie McGrath asked the Minister for Health if a policy on the correct disposal of foetal remains following a termination of pregnancy is being developed nationally; if so, when such a policy will be published; and if he will make a statement on the matter. [2523/19]
Amharc ar fhreagraAs this question relates to a service issue, it has been referred to the HSE for answer.
391. Deputy Pat Deering asked the Minister for Health if a medical card patient has to pay to have a blood test with their general practitioner (details supplied); if not, the procedures in place to allow them not to make the payment; and if he will make a statement on the matter. [2534/19]
Amharc ar fhreagraUnder the terms of the current GMS contract, GPs are required to provide eligible patients with ''all proper and necessary treatment of a kind usually undertaken by a general practitioner and not requiring special skill or experience of a degree or kind which general practitioners cannot reasonably be expected to possess." There is no provision under the GMS GP contract for persons who hold a medical card or GP visit card to be charged for routine phlebotomy services provided by their GP which are required to either assist in the diagnosis of illness or the treatment of a condition.
The HSE has advised GPs that where a blood test forms part of the investigation or necessary treatment of a patient’s symptoms or conditions, this should be free of charge for patients who hold a medical card or GP visit card. Notwithstanding this, I am aware that some GPs are charging GMS patients for phlebotomy services in some circumstances.
This is a matter of concern for me as it has long been the position, under successive Governments, that no user charges should apply to GP services provided to GMS and GP visit card patients. If a patient who holds a medical card or GP visit card believes he or she has been incorrectly charged for routine phlebotomy services by his or her GP, then that patient should report the matter to their HSE Local Health Office.
392. Deputy Thomas Byrne asked the Minister for Health the reason a long-term illness card was removed in the case of a person (details supplied). [2552/19]
Amharc ar fhreagraAs the particular issue raised relates to an individual case, I have arranged for the question to be referred to the HSE for direct reply to the Deputy.
393. Deputy John Brassil asked the Minister for Health his plans to extend the number of day care centres for dementia patients in view of the projected increase of the number of persons who will present with dementia; and if he will make a statement on the matter. [2556/19]
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.
394. Deputy Peter Burke asked the Minister for Health if an appointment for a person (details supplied) will be expedited. [2560/19]
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.
395. Deputy Niamh Smyth asked the Minister for Health the reason a person (details supplied) is waiting on an appointment; the reason appointments have been cancelled so often in the past; if the person will be seen as soon as possible; and if he will make a statement on the matter. [2561/19]
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.
396. Deputy Catherine Martin asked the Minister for Health the reason a mother and baby group provided in a centre (details supplied) was ended; if this was due to a lack of financial resources; and if he will make a statement on the matter. [2562/19]
Amharc ar fhreagraAs this question relates to service matters, I have arranged for the question to be referred to the Health Service Executive (HSE) for direct reply.
399. Deputy Catherine Martin asked the Minister for Health the policy that acknowledges the need to meet the physical and psychological needs of transgender persons; the supports being offered; and the long-term resources being identified in policy terms to bring about such supports. [2568/19]
Amharc ar fhreagraTransgender-specific guidelines have been developed by WPATH (World Professional Association for Transgender Health) and the Endocrine Society (who updated their guidelines in 2017). These guidelines were devised by experts in transgender healthcare, along with members of the International Transgender, Transsexual and LGBT community.
A proposed model of care for transgender children, adolescents and adults was submitted by the HSE Quality Improvement Division to the HSE Divisions of Primary Care, Mental Health and Acute Hospital programme. The model was developed in consultation with key treating clinicians, planners, policy makers, advocates and service users.
The guidelines recommend a comprehensive multidisciplinary psychosocial assessment prior to commencement of hormone therapy by endocrinology services. The assessment focuses on more than just assessment for the possible diagnosis of Gender Dysphoria. The guidelines highlight several criteria which must be met prior to referral for hormonal intervention. It is important that co-morbid conditions are identified and addressed, and that people access the supports that they need to manage co-morbid difficulties, which can impact on response to medical transition (including hormone treatment).
International best practice involves an assessment by a multi-disciplinary team and shared decision making in the best interests of the individual. Both WPATH and the Endocrine Society Guidelines 2017 specify the assessment must be carried out by a mental health professional (s) with experience in transgender healthcare and possess specific skills. Endocrinologists and General Practitioners (GPs) do not possess these skills, and require access to the multidisciplinary team as described. GPs would only see a small number of gender variant individuals during their lifetime in clinical practice, and would not be in a position to build up the requisite skill set outlined in WPATH and Endocrine Society Guidelines or have the time resource to conduct a comprehensive evaluation.
Informed consent is essential, whereby benefits and risks of hormone treatment and surgery are discussed with individuals seeking these interventions. Although regret rates are low, it can happen and can also lead to high levels of psychological distress. Healthcare providers work with people to try to prevent negative outcomes. The emerging evidence on good outcomes following medical and/or surgical transitioning is based on use of multi-disciplinary psychosocial assessment, fulfilment of criteria for hormones and on-going psychological support throughout the process. It is important that psychological support is available to individuals before, during and after transitioning.
Prescription of hormone blockers and cross-sex hormones for transgender people is relatively new. Significant side effects can occur with cross sex hormones including irreversible physical changes and infertility. There is a lack of long-term research on outcomes. For these reasons the decision to prescribe should only be made by specialists (i.e. Endocrinologists) in consultation with other professionals involved in the assessment process. Shared decision-making is in accordance with best practice internationally. Prescriptions can then be supported by local GPs with specialist guidance.
The Best Practice approach as outlined above is endorsed in the Service Development Model as developed by the Quality Improvement Division of the HSE in 2017, in collaboration with TENI. This model is providing the framework for the development of National Gender Clinics and MDTs for children and adults, funded by the Acute Hospitals and Mental Health Divisions of the HSE. Recruitment commenced to develop these national teams in 2018.
The new posts includes one consultant endocrinologist (adult services), one consultant endocrinologist (paediatric services), one social worker (adult services), one speech and language therapist (adult services), one senior psychologist (adult services), one senior psychologist (paediatric services), one clinical nurse specialist (Paediatric services), two administrative support officers (adult and paediatric services). This investment is a concerted measure by the HSE to address the waiting times and immediate service needs of children, adolescents and adults in transition.
The HSE is committed to building mental health, acute hospital and primary care services for transgender children, adolescents and adults in accordance with international best practice.
400. Deputy Catherine Martin asked the Minister for Health when he plans to bring forward legislation for safety or exclusion zones around hospitals and primary care centres which provide terminations; and if he will make a statement on the matter. [2578/19]
Amharc ar fhreagraIt is my intention to introduce legislation to ensure safe access to premises in which termination of pregnancy services may be provided. The purpose of the legislation would be to allow patients, service providers, healthcare staff and members of the public to enter such premises without fear of intimidation or harassment.
While it was originally intended to provide for such safe access in the Health (Regulation of Termination of Pregnancy) Bill 2018, a number of legal issues were identified during the drafting process. In order to allow full consideration of these issues, Government approved the drafting of a separate piece of legislation on safe access to health services.
Officials in my Department will work with the Office of the Attorney General on this legislation.
401. Deputy James Browne asked the Minister for Health his views on whether the decision by a medical service (details supplied) to increase its charge for children’s consultations to €70 is acceptable; the person or body that sets the charge for the service; and if he will make a statement on the matter. [2605/19]
Amharc ar fhreagraUnder the GMS scheme, the HSE contracts with GPs to provide services to provide services to medical card and GP visit card holders. The GP contract stipulates that GPs must make suitable arrangements to enable contact to be made with them, or a locum/deputy, for urgent cases outside normal practice hours. Many GPs choose to participate in GP out of hours cooperatives to meet this contractual obligation.
GPs are reimbursed by the HSE for out of hours consultations they provide to medical card or GP visit card holders. There is no provision under the GMS contract for medical card GP visit card holders to be charged for out of hours consultations provided by their GP or an out of hours provider acting on behalf of their GP.
People who do not hold a medical card or GP visit card access GP services on a private basis, including GP out of hours services. I have no role in relation to the fees charged by individual GPs or GP out of hours service providers for private consultations, as these are a matter of private contract between the clinicians and their patients.
402. Deputy Robert Troy asked the Minister for Health if an application by a person (details supplied) for a medical card will be expedited. [2607/19]
Amharc ar fhreagraAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly.
403. Deputy Clare Daly asked the Minister for Health the staffing levels of midwives in HSE maternity units and maternity hospitals; and the number by which these staff numbers fall short of or exceed the birth rate plus metric. [2608/19]
Amharc ar fhreagraI have asked the HSE to respond to you directly on this matter.
404. Deputy Thomas P. Broughan asked the Minister for Health the number of day places available for training young persons with a disability in each of the years 2015 to 2018, in tabular form; and if he will make a statement on the matter. [2616/19]
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.
405. Deputy Thomas P. Broughan asked the Minister for Health when the HSE will publish its operational plans for 2019 for each sector; and if he will make a statement on the matter. [2617/19]
Amharc ar fhreagraAs this is a service related issue, I have asked the HSE to respond directly to the question raised by the Deputy.
406. Deputy Thomas P. Broughan asked the Minister for Health the steps he is taking to address fears of shortages arising for key heart, cancer and other medicines following alleged stockpiling of medicines in the UK in view of Brexit; and if he will make a statement on the matter. [2620/19]
Amharc ar fhreagra407. Deputy Thomas P. Broughan asked the Minister for Health the action he is taking to source alternative supplies of essential medicines produced in or supplied from the UK in view of reports of stockpiling of medicines in the UK in view of Brexit; and if he will make a statement on the matter. [2621/19]
Amharc ar fhreagraI propose to take Questions Nos. 406 and 407 together.
As part of the whole of Government response to Brexit, my Department is working on a comprehensive and coordinated set of actions to ensure, as far as is possible, continuity of supply of medicines in a disorderly Brexit.
Significant work has already been undertaken by the Department, the HSE, and the Health Products Regulatory Authority (HPRA), together with industry, to ensure that risks to the continuity of supply are mitigated to the greatest possible extent.
There are established multi-stakeholder procedures in place to anticipate and manage medicine shortages and these will be utilised should the need arise as a result of Brexit. In 2018, the HPRA developed and launched a multi-stakeholder Medicines Shortages Framework to mitigate the impact of medicine shortages when they occur, and this framework is used to successfully manage an average of 45 shortage notifications a month. The health system is therefore well placed to anticipate and respond to any additional shortages, should they arise because of Brexit.
There is no need for hospitals, pharmacists or patients to order extra quantities of medicines ahead of Brexit. To do so could, in itself, disrupt existing stock levels and hamper the supply of medicines for other patients.
Both the HPRA and HSE have requested that medicines manufacturers and suppliers highlight any issues regarding the availability of specific products associated with Brexit - to date no major issues have been identified through this process.
408. Deputy John Brassil asked the Minister for Health if he is satisfied with the number of psychiatric nurses recruited in County Kerry in 2018; if he is further satisfied that only temporary contracts were offered; and if he will make a statement on the matter. [2631/19]
Amharc ar fhreagraI have asked the HSE to respond to the Deputy directly on this matter.
