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Thursday, 28 Feb 2019

Written Answers Nos. 130-149

Primary Care Centres Expenditure

Ceisteanna (130)

Clare Daly

Ceist:

130. Deputy Clare Daly asked the Minister for Health the public funding used in the construction of a health facility (details supplied). [10015/19]

Amharc ar fhreagra

Freagraí scríofa

As the HSE has responsibility for the provision, along with the maintenance and operation of Primary Care Centres and other Primary Care facilities, the Executive has been asked to reply directly to the Deputy.

Ambulance Service

Ceisteanna (131)

Brendan Griffin

Ceist:

131. Deputy Brendan Griffin asked the Minister for Health his views on a matter (details supplied) regarding the ambulance service in County Kerry; and if he will make a statement on the matter. [10016/19]

Amharc ar fhreagra

Freagraí scríofa

I have asked the HSE to respond to you directly in relation to ambulance services in Kerry. However, if you would like to forward your correspondence to my Private Office it will be considered in line with normal procedures.

Hospital Waiting Lists

Ceisteanna (132)

Michael Healy-Rae

Ceist:

132. Deputy Michael Healy-Rae asked the Minister for Health when a person (details supplied) will be called for a procedure; and if he will make a statement on the matter. [10018/19]

Amharc ar fhreagra

Freagraí scríofa

Under 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.

Medical Aids and Appliances Applications

Ceisteanna (133)

Michael Healy-Rae

Ceist:

133. Deputy Michael Healy-Rae asked the Minister for Health the status of equipment for a child (details supplied); and if he will make a statement on the matter. [10020/19]

Amharc ar fhreagra

Freagraí scríofa

As this is a service matter it has been referred to the HSE for direct reply to the Deputy.

Health Services

Ceisteanna (134)

Fergus O'Dowd

Ceist:

134. Deputy Fergus O'Dowd asked the Minister for Health the services available to persons who have been adversely affected by the use of defective synthetic vaginal mesh implants; and if he will make a statement on the matter. [10029/19]

Amharc ar fhreagra

Freagraí scríofa

In late 2017, concerns arose 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. 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 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.

Preparation of the report has involved consultation and engagement with national and international bodies. 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.

The Report identifies that for many women, surgical procedures using synthetic mesh devices have provided a more effective and less invasive form of treatment than traditional SUI and POP procedures. However, mesh devices are associated with significant and severe complications in a minority of women. These are of concern given the difficulties of mesh implant removal.

The Report makes 19 recommendations including:

- the development of patient information and informed consent materials;

- surgical professional training and multidisciplinary expertise in units carrying out mesh procedures;

- the development of clinical guidance;

- the development of information systems to monitor the ongoing use of mesh devices;

- ensuring the reporting of mesh related complications; and

- ensuring timely, appropriate and accessible care pathways for the management of women with complications.

The report was completed and published on the Department of Health website on 21 November 2018.

In advance of the report’s completion, the HSE was requested in May 2018 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. The HSE was also asked by the Chief Medical Officer on 24 July to pause all mesh procedures where clinically safe to do so, until a number of key recommendations are implemented.

A Synthetic Mesh Devices Advisory Group has been convened by the HSE, to advise on and progress all of the recommendations. I am informed that an ongoing work programme for the development of appropriate patient information resources and consent materials, and the clarification and development of treatment pathways and appropriate referral services for women suffering from mesh-related complications is being progressed through this Group. The HSE has advised that many women have already engaged with this pathway system and have attended centres for second opinion and follow up appointments.

The Secretary General of my Department wrote to the HSE on November 27 2018 to request that it prepare a detailed Implementation Plan for the complete set of recommendations set out in the CMO’s Report, to be approved by the Leadership Team in the HSE and published on the HSE website within three months of receipt of the report, or sooner if completed. It was also requested that a copy of the Implementation Plan, together with an interim report on the implementation of those recommendations on which work has already commenced, should be submitted to the Department at the time of publication of the Implementation Plan.

I am informed that the HSE in a recent letter to the Secretary General has advised that the final version of the Implementation Plan will be published on its website and submitted to my Department in mid-March 2019.

Child and Adolescent Mental Health Services Data

Ceisteanna (135)

James Browne

Ceist:

135. Deputy James Browne asked the Minister for Health the number of operational CAMHS beds as of 22 February 2019; and if he will make a statement on the matter. [10034/19]

Amharc ar fhreagra

Freagraí scríofa

As this is a service matter I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.

National Children's Hospital

Ceisteanna (136)

James Browne

Ceist:

136. Deputy James Browne asked the Minister for Health the type of beds in the national children’s hospital for CAMHS; and if he will make a statement on the matter. [10035/19]

Amharc ar fhreagra

Freagraí scríofa

The new children’s hospital will include the facilities of a 20 bed acute Child and Adolescent Mental Health (CAMHS) inpatient unit. The provider of the service will be the HSE CAMHS service.

The 20 bed unit will function as two distinct subunits: a 12 bed acute generic CAMHS inpatient unit primarily serving the Greater Dublin and surrounding areas, which will form part of the network of existing CAMHS inpatient units; and an 8 bed national specialist eating disorder unit for those with severe and or complex eating disorders whose needs have not or could not be met in the other CAMHS inpatient units.

Nursing and Midwifery Board of Ireland

Ceisteanna (137)

Clare Daly

Ceist:

137. Deputy Clare Daly asked the Minister for Health if the Nursing and Midwifery Board of Ireland made representations to the HSE with a view to taking over an investigation of a person (details supplied); and if not, the reason therefor. [10046/19]

Amharc ar fhreagra

Freagraí scríofa

The Nursing and Midwifery Board of Ireland made no representations to the HSE regarding the investigation of the individual concerned. Any decision regarding a Fitness to Practice Investigation is solely a matter for the NMBI and I understand that they received no complaints against the individual concerned.

Nursing and Midwifery Board of Ireland

Ceisteanna (138)

Clare Daly

Ceist:

138. Deputy Clare Daly asked the Minister for Health the reason the HSE was permitted to carry out a systems analysis in the case of a person (details supplied) rather than the investigation being given over to the NMBI. [10047/19]

Amharc ar fhreagra

Freagraí scríofa

A decision on the appropriate type of investigation would be a matter for the HSE and I have forwarded the question to them to reply directly to you. Any decision to conduct a Fitness to Practise Investigation is solely a matter for the Nursing and Midwifery Board of Ireland.

Hospital Facilities

Ceisteanna (139)

Louise O'Reilly

Ceist:

139. Deputy Louise O'Reilly asked the Minister for Health if the possibility of establishing a minor injuries unit in Carndonagh Community Hospital to take pressure away from Letterkenny University Hospital will be examined. [10058/19]

Amharc ar fhreagra

Freagraí scríofa

In relation to the particular query raised, as this is a service matter, I have asked the HSE to reply to the Deputy directly.

Misuse of Drugs

Ceisteanna (140)

Louise O'Reilly

Ceist:

140. Deputy Louise O'Reilly asked the Minister for Health further to Parliamentary Question No. 376 of 20 February 2018, when bulletin 7 of the drug prevalence survey 2014-2015, which focuses on gambling, will be published in view of the fact that it was to be released in 2017; and if he will make a statement on the matter. [10059/19]

Amharc ar fhreagra

Freagraí scríofa

Minister Stanton and I released Bulletin 7 of the Drugs Prevalence Survey 2014/15 on the 27th February 2019. This bulletin provides detailed analysis of the first set of data on the extent of gambling in Ireland. The bulletin is published on the Department of Health website, www.health.gov.ie.

The report show that 64.5% of people in Ireland engage in various forms of gambling and that 41.4% report gambling on a monthly basis or more often. For many there are no issues arising from their gambling. However, the report indicates problem gambling prevalence at 0.8%. For the small percentage of people for whom gambling is a problem, we need measures to reduce problem gambling and its impact on individuals and their families.

This survey provides a baseline of data to assist in policy formulation and future planning and action on gambling. It contributes to the evidence base to ensure that the policy and legislative approach to addressing the complex issue of gambling and problem gambling is fit for purpose.

The next drug prevalence survey for the period 2018/19 will again include gambling and will allow for data on trends in gambling to be compiled.

Health Services Reform

Ceisteanna (141)

Louise O'Reilly

Ceist:

141. Deputy Louise O'Reilly asked the Minister for Health the number of times the Sláintecare high-level delivery board has met; the regularity with which it plans to meet in 2019; and if he will make a statement on the matter. [10060/19]

Amharc ar fhreagra

Freagraí scríofa

The High Level Delivery Board comprising the Secretaries General of the Departments of Health, Taoiseach and Public Expenditure and Reform, the CEO of the HSE and the Sláintecare Executive Director will be established to ensure effective delivery of agreed plans and resourcing of the Sláintecare reform programme.

The High Level Delivery Board has yet to convene, however each of the board members have been involved the development of the Sláintecare Action Plan and have provided input into the plan. It is one of the deliverables of the Sláintecare Action Plan 2019 for the Board to convene, and following publication of the Action Plan shortly, it is intended that the Board will hold bi-monthly meetings.

Hospital Appointments Administration

Ceisteanna (142)

Louise O'Reilly

Ceist:

142. Deputy Louise O'Reilly asked the Minister for Health the number of hospital appointments cancelled by the endocrinology clinic in St. Columcille's Hospital, Loughlinstown, in each of the years 2014 to 2018 and to date in 2019; the number cancelled by the patient or the clinic, respectively; and if he will make a statement on the matter. [10061/19]

Amharc ar fhreagra

Freagraí scríofa

In relation to the particular query raised, as this is a service matter, I have asked the HSE to respond to the Deputy directly.

Hospital Waiting Lists

Ceisteanna (143)

Louise O'Reilly

Ceist:

143. Deputy Louise O'Reilly asked the Minister for Health the number of persons on waiting lists for the endocrinology clinic in St. Columcille's Hospital, Loughlinstown; the number of persons on the waiting lists in February 2016, 2017 and 2018; and if he will make a statement on the matter. [10062/19]

Amharc ar fhreagra

Freagraí scríofa

I am conscious that waiting times are often unacceptably long and of the burden that this places on patients and their families. In this regard, I am committed to improving waiting times for hospital appointments and procedures.

The information requested by the Deputy is set out below.

St Columcille’s Hospital Endocrinology Outpatients Waiting List February 2016

0-3 mths

3-6 mths

6-9 mths

9-12 mths

12-15 mths

15-18 mths

18+ mths

Total

189

264

198

156

97

128

301

1333

St Columcille’s Hospital Endocrinology Outpatients Waiting List February 2017

0-3 mths

3-6 mths

6-9 mths

9-12 mths

12-15 mths

15-18 mths

18+ mths

Total

260

217

179

160

101

147

590

1654

St Columcille’s Hospital Endocrinology Outpatients Waiting List February 2018

0-3 mths

3-6 mths

6-9 mths

9-12 mths

12-15 mths

15-18 mths

18+ mths

Total

224

179

226

171

203

178

765

1946

St Columcille’s Hospital Endocrinology Outpatients Waiting List January 2019

0-3 mths

3-6 mths

6-9 mths

9-12 mths

12-15 mths

15-18 mths

18+ mths

Total

243

174

208

184

156

143

976

2084

Medicinal Products Reimbursement

Ceisteanna (144, 156)

Brendan Smith

Ceist:

144. Deputy Brendan Smith asked the Minister for Health when it is expected that the assessment in respect of nusinersen will be finalised by the HSE leadership team and decisions made; and if he will make a statement on the matter. [10065/19]

Amharc ar fhreagra

Lisa Chambers

Ceist:

156. Deputy Lisa Chambers asked the Minister for Health the stage the application for the reimbursement of Spinraza is at with the rare disease technical review committee, the HSE drugs group or the HSE leadership team; and if he will make a statement on the matter. [10111/19]

Amharc ar fhreagra

Freagraí scríofa

I propose to take Questions Nos. 144 and 156 together.

The Health Service Executive has statutory responsibility for decisions on pricing and reimbursement of medicines, in accordance with the Health (Pricing and Supply of Medical Goods) Act 2013.

The Act specifies the criteria to be applied in the making of reimbursement decisions which include the clinical and cost effectiveness of the product, the opportunity cost and the impact on resources that are available to the HSE.

I am advised by the HSE that an application for the reimbursement of Nusinersen (Spinraza) was considered by HSE Leadership at its meeting on 12 February 2019.

Following detailed consideration of the application, the HSE Leadership made the decision that it was unable to recommend reimbursement of Spinraza and concluded that the evidence for clinical effectiveness is still quite limited and that the current price proposed by the manufacturer was not a cost-effective use of resources.

The HSE has written to the company involved and informed them of the proposal to refuse reimbursement at the current price offering. Under the requirements of the Health (Pricing and Supply of Medical Goods) Act 2013 the company now has 28 days to respond or make representations to the HSE’s proposed decision.

The HSE remains open to considering any new evidence or information which emerges regarding the clinical effectiveness or price of this medicine.

Cancer Services Provision

Ceisteanna (145)

Joan Burton

Ceist:

145. Deputy Joan Burton asked the Minister for Health his plans to ensure the security of fragile chemotherapy compounding at present and into the future, particularly in the context of the United Kingdom leaving the European Union; and if he will make a statement on the matter. [10068/19]

Amharc ar fhreagra

Freagraí scríofa

Systemic Anti-Cancer Therapy (SACT - Chemotherapy) is administered in 26 public hospitals. Of these, 17 have aseptic compounding units and are largely self-sufficient in regard to their SACT needs. The remaining 9 rely on outsourcing - purchasing compounded SACT from a licensed provider. While this need is partly met by an Irish-based supplier, approximately 15% of compounded SACT is sourced from the United Kingdom at present.

As part of the overall Government response to the planned exit of the United Kingdom from the European Union, my Department and the HSE are working on a comprehensive and coordinated set of actions to ensure, as far as is possible, continuity of supply of all medicines post-Brexit, with a clear focus on particularly important medicines such as compounded chemotherapy treatments.

Medicinal Products Supply

Ceisteanna (146)

Joan Burton

Ceist:

146. Deputy Joan Burton asked the Minister for Health his plans to ensure an uninterrupted supply of chemotherapy drugs in the context of the United Kingdom leaving the European Union; his further plans to ensure the availability of individually compounded treatments for cancer patients; his plans to avoid disruption to chemotherapy treatment; his further plans proposed or put in place to safeguard supplies; and if he will make a statement on the matter. [10069/19]

Amharc ar fhreagra

Freagraí scríofa

As part of the overall 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 the event of a "no-deal" Brexit.

Significant work has been undertaken by my Department, the HSE, and the Health Products Regulatory Authority (HPRA), together with medicines manufacturers and suppliers, to ensure that risks to the continuity of supply are mitigated to the greatest possible extent.

The Department of Health, HSE and HPRA do not anticipate an immediate impact on medicine supplies should there be a no-deal Brexit on 29 March. There are already additional stocks of medicines routinely built into the Irish medicine supply chain, and these additional stocks, together with planning by Revenue to allow the fast-tracking of essential drugs into Ireland, where necessary, will help deal with any delays that may arise.

It is important to note that there is no need for hospitals, pharmacists or patients to order extra quantities of medicines, or for doctors to issue additional prescriptions. To do so could disrupt existing stock levels and hamper the supply of medicines for other patients.

In 2018, the HPRA developed and launched a multi-stakeholder Medicine Shortages Framework to anticipate and manage medicine shortages when they occur. The health system is therefore well placed to anticipate and respond to any additional shortages, should they arise because of Brexit.

As an additional safeguard, my Department requested that consideration be given to those categories of medicines which are considered most essential to public health, including compounded chemotherapy treatments. As a result, HSE and HPRA technical experts are undertaking a process to verify the contingency planning in place for the continuity of supply of medicines essential to public health, in order to determine those medicines that have the potential to be vulnerable to supply disruption and, where necessary, identify clinically appropriate alternatives. Work on this process is ongoing and will continue in the months before and after Brexit.

Both the HPRA and HSE have been in contact with manufacturers and suppliers to verify capacity, availability of raw materials and consumables, and contingency planning for supply routes of finished products. To date, no major issues have been identified through this process.

Pharmacy Services

Ceisteanna (147)

Joan Burton

Ceist:

147. Deputy Joan Burton asked the Minister for Health the policy regarding in-house pharmacists in hospitals, particularly in respect of specialised drugs such as chemotherapy drugs; if his attention has been drawn to the views of pharmacists that their continued development within hospitals could lead to savings; and if he will make a statement on the matter. [10070/19]

Amharc ar fhreagra

Freagraí scríofa

These issues are currently being deliberated as part of a consultative process in the Workplace Relations Commissions and it would not be appropriate to comment at this stage.

Primary Medical Certificates Applications

Ceisteanna (148)

Peter Burke

Ceist:

148. Deputy Peter Burke asked the Minister for Health if an application for a primary medical certificate by a person (details supplied) will be expedited; and if he will make a statement on the matter. [10073/19]

Amharc ar fhreagra

Freagraí scríofa

As the Deputy's question relates to service matters, I have arranged for the question to be referred to the Health Service Executive for direct reply to the Deputy.

Long-Term Illness Scheme Coverage

Ceisteanna (149)

Mick Wallace

Ceist:

149. Deputy Mick Wallace asked the Minister for Health if the long-term illness scheme will be extended to include patients with mental illness who are over 16 years of age; and if he will make a statement on the matter. [10076/19]

Amharc ar fhreagra

Freagraí scríofa

The Long Term Illness (LTI) Scheme was established under Section 59(3) of the Health Act 1970 (as amended). The conditions covered by the LTI are: acute leukaemia; mental handicap; cerebral palsy; mental illness (in a person under 16); cystic fibrosis; multiple sclerosis; diabetes insipidus; muscular dystrophies; diabetes mellitus; parkinsonism; epilepsy; phenylketonuria; haemophilia; spina bifida; hydrocephalus; and conditions arising from the use of Thalidomide. Under the LTI Scheme, patients receive drugs, medicines, and medical and surgical appliances directly related to the treatment of their illness, free of charge.

There are no plans to extend the list of conditions covered by the Scheme at this time. However, I wish to inform the Deputy that it is proposed that the LTI Scheme would be included as part of a review of the basis for existing hospital and medication charges, to be carried out under commitments given in the Sláintecare Implementation Strategy.

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