International Agreements

Ceisteanna (397)

Stephen Donnelly

Ceist:

397. Deputy Stephen S. Donnelly asked the Minister for Health if Ireland's full participation in the four pillars of the BeNeLuxA collaboration, including information sharing, horizon scanning, joint assessment and joint pricing and reimbursement, will require amendments to existing national legislation or statutory instruments. [8125/19]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

On the 22 June 2018, I signed the Beneluxa Initiative on Pharmaceutical Policy to work with Austria, Belgium, the Netherlands and Luxembourg.

The BeNeLuxA collaboration was established in 2015, with a view to taking a collective approach to pharmaceutical procurement and evaluation. Four areas of collaboration has been identified: horizon scanning, health technology assessment, information sharing and policy exchange and joint price negotiations.

Members can determine the scope of their voluntary participation in each of the domain areas. It is envisaged that Ireland will over time become involved in all areas of collaboration.

There is ongoing collaborative work between officials from my Department and national experts from other member countries across the different Domain Task Forces to establish the legislative framework underpinning each administration's pricing and reimbursement system. All member countries have different legislative frameworks and there is an acceptance that cooperation has to conform with the legislation that exists, pending any statutory change that may be brought forward by respective administrations.

International Agreements

Ceisteanna (398)

Stephen Donnelly

Ceist:

398. Deputy Stephen S. Donnelly asked the Minister for Health his plans to undertake a regulatory impact assessment and-or a cost-benefit analysis of Ireland's participation in the BeNeLuxA initiative. [8126/19]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

On the 22 June 2018, I signed the Beneluxa Initiative on Pharmaceutical Policy to work with Austria; Belgium; the Netherlands and Luxembourg. This Agreement is in line with my objective to work with other European countries to identify workable solutions, in an increasingly challenging environment, to secure timely access for patients to new medicines in an affordable and sustainable way.

Successful collaboration with like-minded countries is one policy lever that is being pursued by the Government to enable us improve long-term access to innovative drugs at affordable prices, thereby providing clear benefit to all stakeholders. It is essentially an administrative collaboration whereby Members of Beneluxa will work together to identify pragmatic solutions to the challenges which we all now face with medicines pricing, sustainability and supply. Insofar as a Regulatory Impact Assessment is a tool used for structured exploration of different options to address a particular policy issue, I would not see it as appropriate in this case. The costs involved with our cooperation with other Member countries are minimal and I believe the benefits in the long term have the potential to be significant.

International Agreements

Ceisteanna (399)

Stephen Donnelly

Ceist:

399. Deputy Stephen S. Donnelly asked the Minister for Health if his officials have engaged with officials from other member states on the establishment of the international horizon scanning initiative; the status of progress; and if Ireland will be a participant in the initiative. [8127/19]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

On the 22 June 2018, I signed the Beneluxa Initiative on Pharmaceutical Policy to work with Austria; Belgium; the Netherlands and Luxembourg. The Beneluxa collaboration was established in 2015, with a view to taking a collective approach to pharmaceutical procurement and evaluation. This Initiative seeks to enhance patients' access to high quality and affordable treatments, improve the payers' position in the market through joint negotiations, increase transparency on pricing between the collaborating countries, share policy expertise and focus on knowledge building.

Four areas of collaboration has been identified: horizon scanning, health technology assessment, information sharing and policy exchange and joint price negotiations. Under the domain of horizon scanning, Beneluxa have been developing a shared International Horizon Scanning Initiative (IHSI) where validated information on new medicines entering the market would be available to members. It will provide for national planning and allocation of resources. It will also allow members to explore possible voluntary collaboration on joint price negotiations. Participation in this initiative is open to non Beneluxa countries.

Since 2017, officials from my Department have been engaged with officials from other member states on the technical and procedural preparations for this initiative.

The preparations are now in their final stages and Ireland has signalled its interest in this project.

The next stage of the project will involve a procuring process to select the appropriate company/companies to complete the necessary work and services for an international horizon scan.

International Agreements

Ceisteanna (400)

Stephen Donnelly

Ceist:

400. Deputy Stephen S. Donnelly asked the Minister for Health his views on whether the fiduciary duties of directors of Irish registered legal entities that are wholly owned subsidiaries under the Companies Act 2014 may preclude these companies from engaging in joint pricing and reimbursement negotiations that may occur as part of the BeNeLuxA collaboration; and his views on whether this could be a barrier to Irish registered companies engaging in future pilot joint negotiations. [8128/19]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

On the 22 June 2018, I signed the Beneluxa Initiative on Pharmaceutical Policy to work with Austria, Belgium, the Netherlands and Luxembourg.

The BeNeLuxA collaboration was established in 2015, with a view to taking a collective approach to pharmaceutical procurement and evaluation. Four areas of collaboration have been identified:

Horizon Scanning

Beneluxa are developing a shared International Horizon Scanning Initiative (IHSI) where validated information on new medicines entering the market would be available to members. It will provide for national planning and allocation of resources. It will also allow members to explore possible voluntary collaboration on joint price negotiations. Participation in this area is open to non Beneluxa countries.

Health Technology Assessment

Collaboration on Health Technology Assessment would allow for an early exchange of opinions and where relevant, adopt a shared point of view on new innovative medicines.

Information sharing and policy exchange

Collaboration on information and policy exchange has the potential to improve affordability and access to innovative medicines.

Pricing and Reimbursement (to include joint negotiations)

By combining patient volumes with other Member States and collaborating on pricing, the potential exists to secure affordable access to innovative medicine.

Members can determine the scope of their voluntary participation in each of these domain areas. It is envisaged that Ireland will over time become involved in all areas of collaboration.

Ireland joined the collaboration on the understanding that it is an entirely voluntary process and would allow for whatever level of participation in each of the Domain Task Forces that is deemed appropriate. Participation in this collaborative initiative is underpinned by the understanding that collaboration would have to accord to domestic legal frameworks on drug pricing in each country and crucially, respect the fact that pricing and reimbursement decisions would remain a national competency.

It is in this context, that there is ongoing collaborative work between officials from my Department and national experts from the other Member States on the different Domain Task Forces to establish how each country’s assessment and reimbursement processes operate. This work will in due course be broadened to assess any barriers to cooperation, whether legislative or otherwise, and it is in this vein that the matters raised by the Deputy will be considered in due course.

HSE Reports

Ceisteanna (401)

Aindrias Moynihan

Ceist:

401. Deputy Aindrias Moynihan asked the Minister for Health when the report of the national out of hospital cardiac arrest steering group will be finalised and published; and if he will make a statement on the matter. [8144/19]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

The Out of Hospital Cardiac Arrest Steering Group was established by the Health Service Executive and, as such, it has been referred to the HSE for attention and direct reply to the Deputy.

National Children's Hospital Expenditure

Ceisteanna (402)

Jonathan O'Brien

Ceist:

402. Deputy Jonathan O'Brien asked the Minister for Health if he sought a report or update on the project and procurement process, including the negotiation of the guaranteed maximum price, before reappointing the National Paediatric Hospital Development Board; and if he will make a statement on the matter. [8146/19]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

The National Paediatric Hospital Development Board was established on 23 May 2007 in accordance with the National Paediatric Hospital Development Board (Establishment) Order 2007 (Statutory Instrument No 246 of 2007). Article 9 of the Order sets out the mechanism for the appointment of the 13-member Board. The term of office of Board members appointed in July 2013 came to an end in July 2018 on completion of the five-year term specified in the Order.

The Children's Health Act 2018, which was enacted in November 2018 and commenced in December 20128, amended the provision relating to the appointment of the ordinary Board members to better reflect the competency-requirements for the Board for the next phase of the project. The Act also includes a provision which, on commencement, provides that the Board in existence at the time of commencement will cease to be in office. Accordingly, in July 2018, in the interests of maintaining stability at Board level during the critical period for this large-scale and complex capital project, including completing the work on agreement of a Guaranteed Maximum Price and mindful of a request from the outgoing Chairperson that consideration be given to the reappointment of the outgoing Board pending the appointment of a new Board through the anticipated legislative amendments, I reappointed the Board members. This was done with the knowledge of all parties that their term of office would be until such time as new appointments were made in line with the new legislative provision.

Capital Expenditure Programme

Ceisteanna (403, 405, 406, 407)

Marc MacSharry

Ceist:

403. Deputy Marc MacSharry asked the Minister for Health the impact the announced reprofiling of €100 million in capital expenditure will have on the new 27-bed inpatient mental health unit to serve counties Sligo and Leitrim at Sligo University Hospital (details supplied); if the proposed completion date of the fourth quarter of 2019 will be affected; the position regarding the progress of the unit; the timeline for the construction and delivery of the project; and if he will make a statement on the matter. [8152/19]

Amharc ar fhreagra

Marc MacSharry

Ceist:

405. Deputy Marc MacSharry asked the Minister for Health the health capital projects that will be directly affected in view of the announced reprofiling of €100 million in capital expenditure; the delay or impact this will have on the process relevant to the delivery of the new Sheil Community Hospital development at Ballyshannon, County Donegal; the status of the project; the timeline for its construction and delivery; and if he will make a statement on the matter. [8154/19]

Amharc ar fhreagra

Marc MacSharry

Ceist:

406. Deputy Marc MacSharry asked the Minister for Health the health capital projects which will be directly affected in view of the announced reprofiling of €100 million in capital expenditure; the delay or impact this will have on the process relevant to the delivery of the new St. Patrick's Hospital development at Carrick-on-Shannon, County Leitrim; the status of the project; the timeline for its construction and delivery; and if he will make a statement on the matter. [8155/19]

Amharc ar fhreagra

Marc MacSharry

Ceist:

407. Deputy Marc MacSharry asked the Minister for Health the methodology being applied to determine the projects to be delayed, paused or cancelled as a result of the announced reprofiling of €100 million in capital expenditure; and if he will make a statement on the matter. [8156/19]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

I propose to take Questions Nos. 403 and 405 to 407, inclusive, together.

The new children’s hospital is a vital and much needed project. The Government has examined the funding pressures associated with delivering this important project and has made adjustments to capital allocations to ensure that the new children’s hospital will be delivered.

My Department and the Health Service Executive are currently engaged in a process to finalise the HSE Capital Plan for 2019. The HSE Capital Plan will determine the projects that can progress in 2019 and beyond having regard to the total available capital funding and the relevant priority of each project. All Health capital projects, currently at various stages of development, such as the projects in Leitrim, Donegal and Sligo, are included as part of this process.

In developing its Capital Plan for 2019 and future years, the HSE must consider a range of issues including, the expenditure that is contractually committed, the HSE’s annual requirement in relation to meeting risks associated with clinical equipment, ambulances and healthcare infrastructure and the total capital exchequer funding required for the new children’s hospital.

Once the HSE has finalised its Capital Plan for 2019, it will then be submitted to me for consideration.

As the Health Service Executive is responsible for the delivery of healthcare infrastructure projects, I have asked the HSE to outline to you directly the current status of the projects specified in your questions.

National Children's Hospital Expenditure

Questions Nos. 405 to 407, inclusive, answered with Question No. 403.

Ceisteanna (404)

Michael McGrath

Ceist:

404. Deputy Michael McGrath asked the Minister for Health the provision on construction tender inflation in the contract regarding the guaranteed maximum price of €1.433 billion for the construction of the national children's hospital; the agreed method of measuring construction tender inflation under the contract; the extra amount that must be paid for each 1% that construction tender inflation exceeds the agreed threshold of 4%; and if he will make a statement on the matter. [8153/19]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

There are clearly defined procedures around the recovery of excessive tender inflation in relation to the build cost for this project. The Guaranteed Maximum Price (GMP) procurement process agreed with the contractors requires the contractors to take all risk for quantities following completion of the GMP process, and, as per the contract, limits their recovery of additional costs incurred by them to clearly defined scope changes and in excess of 4% inflation (as per the average of three published tender price indices) which may occur post July 2019. In relation to the extra amount that must be paid for each 1% that construction tender inflation exceeds the agreed threshold of 4%, I have asked the National Paediatric Hospital Development Board to reply to you directly.

The independent review underway into the cost escalation associated with the new children's hospital construction project, as part of its Terms of Reference, will comment on the major residual risks and the robustness/completeness of the current forecasts and, where possible, quantify those risks contractually excluded from the GMP/adjusted contract sum. This review is expected to be completed by the end of March 2019.

Questions Nos. 405 to 407, inclusive, answered with Question No. 403.

National Children's Hospital Expenditure

Ceisteanna (408)

Michael Fitzmaurice

Ceist:

408. Deputy Michael Fitzmaurice asked the Minister for Health if there will be a delay in the delivery of a number of hospital builds (details supplied) due to the overspend on the national children’s hospital; and if he will make a statement on the matter. [8159/19]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

The new children’s hospital is a vital and much needed project. The Government has examined the funding pressures associated with delivering this important project and has made adjustments to capital allocations to ensure that the new children’s hospital will be delivered.

My Department and the Health Service Executive are currently engaged in a process to finalise the HSE Capital Plan for 2019.

The HSE Capital Plan will determine the projects that can progress in 2019 and beyond having regard to the total available capital funding and the relevant priority of each project. All Health capital projects, currently at various stages of development, such as the projects referred to in Roscommon and Galway, are included as part of this process.

Once the HSE has finalised its Capital Plan for 2019, it will then be submitted to me for consideration.

General Practitioner Services

Ceisteanna (409)

Maurice Quinlivan

Ceist:

409. Deputy Maurice Quinlivan asked the Minister for Health if his attention has been drawn to the fact that some general practitioners in County Limerick charge for the taking of blood; the steps he will take to enforce the provisions of the Health Act 1970 to ensure that persons covered by the general medical services scheme are not being incorrectly charged for routine phlebotomy services; and if he will make a statement on the matter. [8195/19]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

Under 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.

National Children's Hospital Expenditure

Questions Nos. 411 and 412 answered with Question No. 359.

Ceisteanna (410)

Thomas Pringle

Ceist:

410. Deputy Thomas Pringle asked the Minister for Health if funding will remain available for the upgrade of the Sheil Community Hospital in Ballyshannon, County Donegal in view of savings required due to the overrun of costs for the national children's hospital; and if he will make a statement on the matter. [8198/19]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

The new children’s hospital is a vital and much needed project. The Government has examined the funding pressures associated with delivering this important project and has made adjustments to capital allocations to ensure that the new children’s hospital will be delivered.

My Department and the Health Service Executive are currently engaged in a process to finalise the HSE Capital Plan for 2019.

The HSE Capital Plan will determine the projects that can progress in 2019 and beyond having regard to the total available capital funding and the relevant priority of each project. All Health capital projects, currently at various stages of development, such as the Community Hospital in Ballyshannon, are included as part of this process.

Once the HSE has finalised its Capital Plan for 2019, it will then be submitted to me for consideration.

Questions Nos. 411 and 412 answered with Question No. 359.

Services for People with Disabilities

Ceisteanna (413)

Seán Fleming

Ceist:

413. Deputy Sean Fleming asked the Minister for Health if an appointment will be expedited for a child (details supplied); and if he will make a statement on the matter. [8201/19]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

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.

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.

Cancer Screening Programmes

Question No. 415 answered with Question No. 328.

Ceisteanna (414)

Louise O'Reilly

Ceist:

414. Deputy Louise O'Reilly asked the Minister for Health if a copy of the advice given to him recommending the move to offer additional out of cycle smear tests following the CervicalCheck scandal by the chief medical officer will be provided. [8202/19]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

On 28 April 2018, I made the decision to provide for a free out of cycle smear test for any woman who was concerned, if her GP considered she should have a further test as part of her reassurance.

The decision was made in consultation with senior officials, including the Chief Medical Officer, whose advice in this regard was reflected in the press statement issued on the 28 April which said that, “for any woman who has had a CervicalCheck smear test and where her GP feels she should have a further test as part of her reassurance, the Minister has asked CervicalCheck to make the necessary arrangements, including payment provision. These arrangements will be confirmed next week."

A fee to provide for this free repeat smear was subsequently agreed with the Irish Medical Organisation.

Question No. 415 answered with Question No. 328.

Treatment Abroad Scheme

Ceisteanna (416)

Martin Ferris

Ceist:

416. Deputy Martin Ferris asked the Minister for Health when a person (details supplied) will receive a decision on an application under the treatment abroad scheme; and if he will make a statement on the matter. [8206/19]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

As this is a service matter, it has been referred to the Health Service Executive for attention and direct reply to the Deputy.

Services for People with Disabilities

Ceisteanna (417)

Thomas Byrne

Ceist:

417. Deputy Thomas Byrne asked the Minister for Health if a children's disability respite house (details supplied) services children in County Meath. [8209/19]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

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.

The Programme for Partnership Government states that the Government wishes to provide more accessible respite care to facilitate full support for people with a disability.

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.

Capital Expenditure Programme

Ceisteanna (418)

Pat the Cope Gallagher

Ceist:

418. Deputy Pat The Cope Gallagher asked the Minister for Health his plans for funding the necessary upgrade works at three community hospitals (details supplied) in County Donegal; if his attention has been drawn to the fact that all three projects are deferred and no new capital budget exists for these projects and that his previous replies to this Deputy on the matter are not consistent with the current position as forwarded; and if he will make a statement on the matter. [8211/19]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

As you know, it has been decided that St Joseph's Community Hospital Stranorlar and Ramelton Community Hospital will be redeveloped through the HSE's capital programme, while the potential for a development in Lifford will be further reviewed post 2021, when new Census data is available and the capital programme has been advanced.

The National Development Plan provides for the continuation of the programme of replacement and refurbishment of community nursing units and long term residential care facilities for older people.

My Department has consistently stated that the HSE is responsible for the delivery of healthcare infrastructure projects and it is a matter for the HSE, in the first instance to prioritise and plan projects, subject to available funding in the coming years.

My Department and the Health Service Executive are currently engaged in a process to finalise the HSE Capital Plan for 2019. The HSE Capital Plan will determine the projects that can progress in 2019 and beyond having regard to the total available capital funding and the relevant priority of each project.

All Health capital projects, currently at various stages of development, such as the community nursing units in Donegal, are included as part of this process. Once the HSE has finalised its Capital Plan for 2019, it will then be submitted to me for consideration.