Tuesday, 9 Apr 2019

Written Answers Nos. 435-452

Psychological Services

Ceisteanna (435, 436, 437, 438, 439)

Louise O'Reilly

Ceist:

435. Deputy Louise O'Reilly asked the Minister for Health the pathways for adult ADHD diagnosis. [16575/19]

Louise O'Reilly

Ceist:

436. Deputy Louise O'Reilly asked the Minister for Health the waiting lists for adult ADHD diagnosis. [16576/19]

Louise O'Reilly

Ceist:

437. Deputy Louise O'Reilly asked the Minister for Health the number of HSE psychiatrists who deal with adult ADHD diagnosis. [16577/19]

Louise O'Reilly

Ceist:

438. Deputy Louise O'Reilly asked the Minister for Health the public health services available for adults with ADHD. [16578/19]

Louise O'Reilly

Ceist:

439. Deputy Louise O'Reilly asked the Minister for Health the status of the national clinical programme for adults with ADHD. [16579/19]

Freagraí scríofa

Minister of State at the Department of Health

I propose to take Questions Nos. 435 to 439, inclusive, together.

As these are service matters I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.

Health Reports

Ceisteanna (440, 441, 442, 461)

Louise O'Reilly

Ceist:

440. Deputy Louise O'Reilly asked the Minister for Health the reason the Chief Medical Officer when compiling a report on the use of mesh did not facilitate a meeting with women injured by mesh usage (details supplied). [16584/19]

Louise O'Reilly

Ceist:

441. Deputy Louise O'Reilly asked the Minister for Health if an independent investigation will be undertaken to examine the use of mesh implants here. [16585/19]

Louise O'Reilly

Ceist:

442. Deputy Louise O'Reilly asked the Minister for Health the reason women injured by mesh implantations were not and will not be offered an opportunity to give testimony on their experiences (details supplied). [16586/19]

Michael Healy-Rae

Ceist:

461. Deputy Michael Healy-Rae asked the Minister for Health if matters (details supplied) in relation to health problems will be addressed; and if he will make a statement on the matter. [16647/19]

Freagraí scríofa

Minister for Health

I propose to take Questions Nos. 440 to 442, inclusive, and 461 together.

As Minister for Health, I requested Dr. Tony Holohan, Chief Medical Officer, CMO, to draft a report on the use of Uro-Gynaecological Mesh in the surgical treatment of stress urinary incontinence, SUI, and pelvic organ prolapse, POP, in women. The report covers the clinical and technical issues involved in ensuring both:

1. the safe and effective provision of mesh procedures in urogynaecology and

2. an appropriate response to women who suffer complications as a result of undergoing such procedures.

This report has been completed and was published on the Department of Health website on 21 November 2018. Preparation of the report 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 was informed by review of international reports and safety reviews of mesh surgery which have been published in recent years.

The report was informed by the personal experiences and concerns of women who have suffered complications following mesh surgery, including through written representations to me and my Department, those concerns raised in Parliamentary Questions on this subject, and the issues raised by the Mesh Survivors Ireland group at its meeting with me on 14 June 2018. I acknowledge the bravery, commitment and dignity shown by the women I met and by those women who have written to me concerning this issue, in sharing what were often harrowing, deeply personal experiences.

The priority issues relating to patient care which were raised by women suffering complications and by others on their behalf are addressed in the report recommendations and are being addressed by the HSE.

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, were not 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, a number of women whose procedures were postponed wrote to me and my Department expressing concern at the impact that this is having on them personally as they await treatment for the distressing symptoms of SUI, reflecting another important group of women affected directly by this issue.

The CMO’s 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.

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. The Group 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 action all of the recommendations above. The HSE has advised that it is unable to facilitate membership on the Advisory Group to every patient or patient group who has a mesh experience. The NWIHP has sought to have a range of mesh experiences from the patient’s perspective represented by a patient advocate on the Group – including patients who have had mesh with post-operative problems, patients who have had successful mesh surgery and patients who are on the waiting list for a mesh procedure. The HSE advises that women who wish to submit views or submissions to the overall work of the Group should contact the National Women & Infants Health Programme at [e-mail].

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 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.

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 HSE has published a dedicated webpage about vaginal mesh implants, including contact information for women suffering complications, which I hope is a useful resource. This can be found on the HSE website.

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 has advised that the final version of the Implementation Plan will be published on its website and submitted to my Department in coming weeks.

At my recent meeting with the Mesh Survivors Ireland Group on 7 March 2019 I agreed to continue engagement with them on a pathway forward, to ensure that the ongoing clinical management of this patient group is in line with international best practice and emerging evidence.

Hospitals Data

Ceisteanna (443)

Louise O'Reilly

Ceist:

443. Deputy Louise O'Reilly asked the Minister for Health the number of times a black escalation was invoked in each of the years 2011 to 2018 and to date 2019, by hospital in tabular form; and if he will make a statement on the matter. [16589/19]

Freagraí scríofa

Minister for Health

The HSE National Escalation Framework consists of a tiered and incremental suite of actions to be adapted and implemented in hospitals with an ED during times when such hospitals are challenged in matching capacity and demand for acute inpatient care.   

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

Question No. 444 answered with Question No. 434.

Question No. 445 answered with Question No. 350.

Medical Card Administration

Ceisteanna (446)

Seán Fleming

Ceist:

446. Deputy Sean Fleming asked the Minister for Health the process in place for persons with Down's syndrome in receipt of a medical card; if these can be issued for a minimum of a three year basis instead of asking a person with Down syndrome to fill out an online review often on an annual basis; if the practice which occurs on some occasions in which the person with Down syndrome is asked over the phone if they still have Down syndrome will be ceased; and if he will make a statement on the matter. [16609/19]

Freagraí scríofa

Minister for Health

In accordance with the provisions of the Health Act 1970 (as amended), eligibility for a medical card is determined by the HSE. The Act obliges the HSE to assess whether a person is unable, without due hardship, to arrange general practitioner services for himself or herself and his or her family, having regard to his or her overall financial position and reasonable expenditure. The HSE's Expert Group on Medical Need and Medical Card Eligibility also examined in 2014 the issue of awarding medical cards on the basis of illness and concluded that it was not feasible, desirable, nor ethically justifiable to list medical conditions in priority order for medical card eligibility. 

In responding to patients' needs, the HSE has implemented revised processes to provide a more compassionate and more efficient process in the assessment of medical card applications. Such measures include the development of a Burden of Illness questionnaire which is used in selective circumstances where the assessing doctor in the HSE's national medical card unit requires a more comprehensive assessment of an applicant's medical and social circumstances and any resulting undue financial hardship.

The HSE is also required to undertake periodic reviews of eligibility in order to ensure that a person continues to meet the qualifying criteria required to continue holding eligibility. Every effort is made by the HSE, within the framework of the legislation, to provide a medical card application system that is responsive and sensitive to people’s needs, in particular, to take full account of the difficult circumstances in the case of applicants who may be in excess of the income guidelines. If the HSE is made aware that a person has a particular requirement, whether at application or review stage, assistance will be afforded to help that person complete the application. This assistance can be availed of through a person's local health office or by calling LoCall 1890 252 919.

Medical Card Data

Ceisteanna (447)

Seán Fleming

Ceist:

447. Deputy Sean Fleming asked the Minister for Health the number of medical cards and general practitioner visit cards, respectively, that were renewed in 2018; the number of these in which an online review form was requested; if a procedure will be put in place in circumstances in which there is a permanent life medical issue that medical cards can be issued on a much longer term basis which in turn will reduce the administration in the HSE and the pressure, work and upset for persons with conditions such as Down syndrome; and if he will make a statement on the matter. [16610/19]

Freagraí scríofa

Minister for Health

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

Orthodontic Services

Ceisteanna (448)

Seán Haughey

Ceist:

448. Deputy Seán Haughey asked the Minister for Health his plans to introduce preventative orthodontic screening for children as part of the new oral health policy; his further plans to recruit the services of private orthodontists for such screening; if his attention has been drawn to the fact that early intervention is crucial to prevent acute orthodontic issues for children in later life; and if he will make a statement on the matter. [16611/19]

Freagraí scríofa

Minister for Health

On 3 April 2019, I published  Smile agus Sláinte, the new National Oral Health Policy together with my colleague Regina Doherty TD the Minister for Employment Affairs and Social Protection.

The Policy supports a preventive approach. Under the Policy, all children up to 16 years will have available to them eight oral healthcare packages consisting of examinations, assessments (including orthodontic assessments), advice, prevention interventions, emergency care and referral as appropriate. The packages will be provided in a primary care setting by oral healthcare practitioners contracted by the HSE. The Policy supports the development of clinical care pathways to ensure that some aspects of orthodontic care, where appropriate, will be more readily available in a primary dental care practice. Stakeholders including the Dental Council will have an important role in progressing this. 

Dental Services Data

Ceisteanna (449)

Gerry Adams

Ceist:

449. Deputy Gerry Adams asked the Minister for Health the number of children waiting for a public dental assessment in County Louth; the number waiting for 6, 12 and 18 months or longer, respectively; and if he will make a statement on the matter. [16614/19]

Freagraí scríofa

Minister for Health

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

Dental Services Data

Ceisteanna (450)

Gerry Adams

Ceist:

450. Deputy Gerry Adams asked the Minister for Health the number of children in County Louth on the orthodontic waiting list; the number waiting 6, 12, 18 and over 18 months, respectively; and if he will make a statement on the matter. [16615/19]

Freagraí scríofa

Minister for Health

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

Health Services Funding

Ceisteanna (451)

Brendan Smith

Ceist:

451. Deputy Brendan Smith asked the Minister for Health when adequate resources will be provided to an association (details supplied) to ensure an improved level of services for patients; and if he will make a statement on the matter. [16616/19]

Freagraí scríofa

Minister of State at the Department of Health

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

Hospital Staff Recruitment

Ceisteanna (452)

Pat Deering

Ceist:

452. Deputy Pat Deering asked the Minister for Health when an audiologist will be appointed to County Carlow to replace the retiring physician from Carlow District Hospital; and if he will make a statement on the matter. [16617/19]

Freagraí scríofa

Minister for Health

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