Written Answers Nos. 927-951
927. Deputy James Browne asked the Minister for Health when unique health identifiers will be in place for all persons and healthcare providers; and the reason for the delay in their provision in view of the fact that legislation to give effect to identifiers was passed in 2014. [19568/19]
Amharc ar fhreagraI thank the Deputy for asking about the Individual Health Identifier (IHI) which is an important patient safety initiative and a fundamental part of my Department’s eHealth strategy.
It is the intention to embed the IHI into all health systems nationally, across multiple sites and as such, it is a project that will continue for several years. The sequencing of the candidate health systems that will have access to the IHI is determined by criteria such as that relating to clinical benefit resulting from the interaction of those systems with IHI included.
Since the passing of the Health Identifiers Act in 2014, there have been a number of important deliverables on the IHI including the commencement order for the operational use of the IHI throughout Ireland's healthcare system, the establishment of an IHI Register and the implementation of the IHI in eReferrals. Since May 2017 approximately 700,000 IHI numbers have been used for electronic referrals from GPs to Hospitals.
The IHI programme of work is continuing with deliverables under the 2019 Sláintecare Action Plan including the creation of an IHI Office to support the phasing in of the IHI across systems nationally. The setting up of that office is the subject of current engagement with my Department and the HSE. The roll-out of IHI will also be a key pillar of the Health Information System Strategy that the Department has committed to developing as a foundational part of Sláintecare Implementation linking the key areas needed to exploit knowledge and information in a modern health service.
928. Deputy Martin Ferris asked the Minister for Health when a person (details supplied) will receive an appointment with a neurologist; and if he will make a statement on the matter. [19574/19]
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.
929. Deputy Barry Cowen asked the Minister for Health the status of the case of a person (details supplied); and when they can expect an appointment at the Royal Victoria Eye and Ear Hospital. [19584/19]
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.
930. Deputy Catherine Martin asked the Minister for Health the number of families with a ministerial licence to purchase CBD oil with THC; the number of families whose CBD oil with THC treatment is being funded under the primary care reimbursement scheme; the rationale for not including CBD oil without THC under the scheme; the number of families using CBD oil without THC under the direction of consultant neurologists here; his plans to source a quality assured supplier here of medicinal cannabis products (details supplied); and if he will make a statement on the matter. [19586/19]
Amharc ar fhreagraIt is open to a registered medical practitioner to apply for a Ministerial Licence under the Misuse of Drugs Acts 1977 to 2016. Such a licence, if granted, enables the licensee (the medical practitioner) to legally prescribe the Schedule 1 controlled drug - cannabis, containing tetrahydrocannabinol (THC) - for a named patient. Licences have been granted in respect of twenty individual patients.
Cannabidiol (CBD) is derived from cannabis. However, since it does not have psychoactive properties it is not controlled under the Misuse of Drugs Acts, and a Ministerial Licence is not required. CBD oil is sometimes marketed as a nutritional or dietary supplement, however it should be noted that it is not authorised as a medicinal product in Ireland.
The HSE has statutory responsibility for decisions on pricing and reimbursement of medicinal products under the community drug schemes, in accordance with the Health (Pricing and Supply of Medical Goods) Act 2013.
I wish to advise the Deputy that no reimbursement programme currently exists for the reimbursement of medicinal cannabis oil products. However, patients who have a valid medical prescription for medical cannabis and a Ministerial licence and who have sourced a cannabis-based product may submit an application to the HSE for reimbursement approval.
If approval is given, the PCRS, when authorised to proceed, will make the necessary arrangements to cover the costs involved for the patient.
Three patients have a Ministerial licence and have been approved by the HSE for their product and travel costs to the Netherlands.
I have asked the HSE to advise their policy for reimbursement of CBD products and will advise the Deputy as soon as this information is received. The number of families using CBD oil is not known.
Until suitable medical cannabis products are made available in Ireland, prescribers and their patients are sourcing the prescribed product from a pharmacy in The Netherlands, on foot of their medical prescription. Due to current Netherlands government policy, Bedrocan products, sold as cannabis oil formulations, are not currently permitted to be commercially exported from the Netherlands, but are only supplied in the Netherlands on foot of a valid medical prescription when presented to the appropriate pharmacy.
A second pathway for access to medical cannabis is being established, through the Medical Cannabis Access Programme (MCAP). Good progress is being made in establishing the Access Programme but it is not yet in operation. The Programme aims to facilitate access to certain ‘acceptable’ cannabis products which have not been authorised as medicines by a statutory Medicines Competent Authority. Availability of cannabis products that are of an appropriate quality standard and are affordable to patients is critical in establishing the access programme.
Department officials are working intensively on finding solutions to the supply of appropriate products for Irish patients.
Medical practitioners, patients and interested parties are encouraged to consult the Department of Health website which contains information on medical cannabis, including clinical guidance on the use of medical cannabis and details on how a medical practitioner may apply for a Ministerial licence for medical cannabis.
931. Deputy Michael Healy-Rae asked the Minister for Health the status of an appointment in UHK for a person (details supplied); and if he will make a statement on the matter. [19588/19]
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.
932. Deputy Pearse Doherty asked the Minister for Health the clinical cover which will be in place to ensure that speech and language services provided at a hospital (details supplied) continue to be available to service users over the coming months when it is anticipated that the current post holder will be on maternity leave; and if he will make a statement on the matter. [19590/19]
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.
933. Deputy Catherine Martin asked the Minister for Health the breakdown of the use of the €150 million provided in budget 2019 for persons with disabilities; and if he will make a statement on the matter. [19594/19]
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 set out in the Health Service Executive (HSE) National Service Plan (NSP) 2019, the 2018 NSP budget of €1.772.1 billion for disability services was increased by €80.4 million during 2018 to give a final 2018 closing recurring budget of €1.852.5 billion. The 2019 budget also provided for a once-off €15m from the Department of Health's own funds for disability emergency places in 2019.
A total of €1.904 billion has been allocated by the Health Service Executive (HSE) for disability services in 2019. This represents an increase of €51.9 million on the final 2018 closing recurring budget. Taking into account movements during 2018 and the increased allocation in 2019, the total increase on the 2018 NSP Budget was €147.4m. The breakdown of this funding is as follows:
|
Category |
Breakdown of Additional Funding €m |
|
Additional in-year funding |
80.4 |
|
2019 Existing Level of Service Funding |
15.0 |
|
2019 New Developments Funding |
14.5 |
|
Additional Pay Rate Funding |
22.5 |
|
Funding for 2019 Emergency Places (once-off) |
15.0 |
|
Total |
147.4 |
934. Deputy Catherine Martin asked the Minister for Health if his attention has been drawn to the practice of nursing homes requiring separate new prescriptions for respite patients with associated extra dispensing costs and increased risk of medication error; and if he will make a statement on the matter. [19598/19]
Amharc ar fhreagraThe Health Information and Quality Authority is the independent authority established under the Health Act 2007 to drive continuous improvement and to monitor safety and quality in Ireland’s health and personal social care services. Since 2009 all nursing homes - public, voluntary and private have been registered and inspected by HIQA. This responsibility is underpinned by a comprehensive framework, including Care and Welfare Regulations and National Standards which set out what is expected in terms of the service provided to residents, with a focus on continuous development of safe and effective care
The Regulations provide that the person in charge shall ensure that all medicinal products are administered in accordance with the directions of the prescriber of the resident concerned and in accordance with any advice provided by that resident’s pharmacist regarding the appropriate use of the product. The National Standards provide that medicines management policies and procedures are in place that comply with legislative and professional regulatory requirements and best practice guidelines. They ensure that medication is never administered other than for medically identified reasons and as prescribed by a registered prescriber. HIQA has also prepared guidance on medicines management for nursing home providers and this is available on the HIQA website.
Finally, I wish to advise the Deputy that registered providers of nursing home care are obliged to provide an accessible and effective complaints procedure. Any concerns should in the first instance be taken up with the nursing home provider.
935. Deputy Bernard J. Durkan asked the Minister for Health the extent to which persons (details supplied) owe moneys arising from the care of a person in a nursing home under the fair deal scheme; and if he will make a statement on the matter. [19602/19]
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.
936. Deputy Eugene Murphy asked the Minister for Health when home support hours previously assigned to a person (details supplied) will be allocated; and if he will make a statement on the matter. [19610/19]
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.
938. Deputy Gino Kenny asked the Minister for Health the details of all those participating or involved in the cannabis working group; and if he will make a statement on the matter. [19612/19]
Amharc ar fhreagraAs the deputy will be aware, on foot of the conclusions from the Health Products Regulatory Authority’s report ‘Cannabis for Medical Use – A Scientific Review’, I established an Expert Reference Group to advise on the development of a Medical Cannabis Access Programme (MCAP).
The purpose of the MCAP is to facilitate access to cannabis-based products or preparations that are of a standardised quality and which meet an acceptable level of quality assurance during the manufacturing process.
The Expert Reference Group was chaired by Dr Mairín Ryan, Director of Health Technology Assessment at the Health Information and Quality Authority (HIQA), and comprised representation from the areas of oncology, palliative care, anaesthesiology, general practice, adult neurology, paediatric neurology, multiple sclerosis, psychiatry, pharmacy, patients, and ethics as well as representatives from HIQA, the HPRA, the National Medicines Information Centre and the Department of Health.
The Expert Group was tasked with the development of clinical guidance for healthcare professionals treating patients through the MCAP. The output of the work of this group resulted in the clinical guidelines for the Access Programme, which are available on the Department of Health’s website.
The membership of the group was as follows:
Health Information and Quality Authority
Dr Mairín Ryan (Chairperson)
Dr Patricia Harrington
Royal College of Physicians of Ireland
Dr Seamus O’Reilly - Medical Oncologist
Prof Tony O’Brien – Consultant physician in palliative medicine
Dr Peter Widdess-Walsh – Consultant Neurologist
Dr Chris McGuigan - Consultant Neurologist
Dr Bryan Lynch – Paediatric Neurologist
College of Psychiatrists
Dr Mike Scully - Consultant Psychiatrist
The College of Anaesthetists of Ireland
Dr Brendan Conroy - Pain Specialist & Anaesthetist
Irish College of General Practitioners
Dr Des Crowley - General Practitioner
Pharmaceutical Society of Ireland
Dr Cora Nestor
Community Pharmacy representative
Keith O'Hourihane - Pharmacist
Royal College of Surgeons Ireland
Professor David Smith - Ethicist
Patient representative
Joan Jordan - European Patients Academy on Therapeutic Innovation
Aileen Tierney
Health Products Regulatory Authority
Elaine Breslin
Vanessa Lyons
National Medicines Information Service
Claudine Hughes - Chief Pharmacist
Department of Health
Eugene Lennon - Principal Officer
Eamonn Quinn, Maria Egan - Pharmacists
Niamh O’Rourke - National Clinical Effectiveness Committee
939. Deputy Barry Cowen asked the Minister for Health when a person (details supplied) can expect a hospital appointment. [19619/19]
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.
940. Deputy Hildegarde Naughton asked the Minister for Health the cost to the HSE in 2018 and to date in 2019 for the use of private ambulance transport nationally; and if he will make a statement on the matter. [19621/19]
Amharc ar fhreagraAs this is a service issue, I have asked the HSE to reply to you directly.
941. Deputy Hildegarde Naughton asked the Minister for Health the cost to the HSE in 2018 and to date in 2019 of intermediate care operative overtime; and if he will make a statement on the matter. [19622/19]
Amharc ar fhreagra943. Deputy Hildegarde Naughton asked the Minister for Health the cost to the HSE in 2018 and to date in 2019 of intermediate care operative overtime of staff based in County Galway; and if he will make a statement on the matter. [19624/19]
Amharc ar fhreagraI propose to take Questions Nos. 941 and 943 together.
I have asked the HSE to respond to the Deputy directly on this matter.
942. Deputy Hildegarde Naughton asked the Minister for Health the cost to the HSE in 2018 and to date in 2019 for the use of private ambulance transport of patients to and or from University Hospital Galway and Merlin Park University Hospital, Galway; and if he will make a statement on the matter. [19623/19]
Amharc ar fhreagraAs this is a service issue, I have asked the HSE to reply to you directly.
944. Deputy Hildegarde Naughton asked the Minister for Health the number of public patients transported by private ambulance nationally in each of the years 2013 to 2018 and to date in 2019; and if he will make a statement on the matter. [19625/19]
Amharc ar fhreagraAs this is a service issue, I have asked the HSE to reply to you directly.
945. Deputy Hildegarde Naughton asked the Minister for Health the number of public patients transported by private ambulance to and or from University Hospital Galway and Merlin Park University Hospital, Galway in each of the years 2013 to 2018 and to date in 2019; and if he will make a statement on the matter. [19626/19]
Amharc ar fhreagraAs this is a service issue, I have asked the HSE to reply to you directly.
946. Deputy Stephen Donnelly asked the Minister for Health when medical cannabis will go on sale here at licensed pharmacists; the way in which it will be distributed to pharmacists once approved; and the location from which it will be sourced. [19631/19]
Amharc ar fhreagra947. Deputy Stephen Donnelly asked the Minister for Health if companies other than pharmacists will be allowed to apply for licences to distribute medical cannabis. [19632/19]
Amharc ar fhreagra948. Deputy Stephen Donnelly asked the Minister for Health the number of persons here entitled to avail of medical cannabis. [19633/19]
Amharc ar fhreagraI propose to take Questions Nos. 946 to 948, inclusive, together.
The Medical Cannabis Access Programme
As the deputy is aware, the Health Products Regulatory Authority’s (HPRA) report ‘Cannabis for Medical Use – A Scientific Review’ recommended that if access to cannabis is to be permitted for medical purposes, it's use should only be initiated as part of a structured process of formal on-going clinical evaluation, in a limited number of clearly defined medical conditions, which have failed to respond to all other previous treatments, and where there is at least modest evidence that cannabis may be effective.
All such patients should be under the direct supervision of an appropriately trained and experienced medical consultant. The specified medical conditions (medical indications) are:
- Spasticity associated with multiple sclerosis;
- Intractable nausea and vomiting associated with chemotherapy;
- Severe, refractory (treatment-resistant) epilepsy.
The purpose of the Medical Cannabis Access Programme is to facilitate access to cannabis-based products or preparations that are of a standardised quality and which meet an acceptable level of quality assurance during the manufacturing process.
The Medical Cannabis Access Programme has not yet been established but good progress is being made:
1. clinical guidelines have been drawn up and published,
2. secondary legislation is being drafted to underpin the Programme,
3. cannabis products for use under the Programme, once reviewed for suitability for medical use, will be published on an ‘approved list’.
Department officials are working intensively on finding solutions to the supply of appropriate products for Irish patients.
Ministerial Licence
In the meantime it is open to a medical practitioner wishing to prescribe cannabis for medical purposes for an individual patient under their care, to apply to the Minister for Health for a licence, under Section 14 of The Misuse of Drugs Acts 1977 to 2016 and the Regulations made thereunder.
It should be noted that it is the decision of the clinician, in consultation with their patient, to prescribe or not prescribe a particular treatment for a patient under their care. As such, medical cannabis products will not be distributed without a prescription at licensed pharmacists, and it is not envisaged that companies other than licensed pharmacists will engage in retail sales of medical cannabis.
In line with the Chief Medical Officer's advice, the granting of a licence for cannabis for medical purposes must be premised on an appropriate application being submitted to the Department of Health, which is endorsed by a consultant who is responsible for the management of the patient and who is prepared to monitor the effects of the treatment over time.
To date licences have been issued in respect of twenty individual patients under this provision of the Act.
It is intended that the Ministerial licence application scheme will continue to operate in parallel with the Cannabis for Medical Use Access Programme, after the programme becomes operational, for exceptional cases only where there is an unmet clinical need.
Department of Health Website
The Department of Health website contains detailed information on medical cannabis, including clinical guidance on the use of medical cannabis. It is updated in the event of new developments on the issue.
949. Deputy Michael Fitzmaurice asked the Minister for Health if his attention has been drawn to the confusion over the licensing of Civil Defence volunteers by the Pre-Hospital Emergency Care Council to practice as emergency medical technicians or above; if the level of medical care that Civil Defence volunteers are able to provide at the moment is downgraded, if the ambulance service will be able to deal with the increased workload; and if he will make a statement on the matter. [19636/19]
Amharc ar fhreagraThe Pre-Hospital Emergency Care Council (PHECC) is an independent statutory body with responsibility for professional regulation in the area of pre-hospital emergency care including the recognition of professional qualifications. Accordingly, the Deputy's query has been referred to PHECC for direct response.
950. Deputy Tony McLoughlin asked the Minister for Health the reason the HSE is not facilitating the availability and treatment of vitamin C intravenous treatment for recovering cancer patients in the north-west (details supplied); the reason the treatment is not available through general practitioners in the north-west region; the reason it is not licensed or available to pharmacies in the region in view of the success of same; and if he will make a statement on the matter. [19650/19]
Amharc ar fhreagraThe most appropriate treatment for a patient is a decision to be made by the treating clinician together with his or her patient. However, any treatment, medication or therapy prescribed for a patient must be safe, evidence-based and in the patient’s best interests.
Some limited studies have been conducted on the potential use of vitamin C (also known as ascorbic acid or ascorbate) in oncology but there is currently insufficient evidence to support the safe and effective use of high dose vitamin C to either help alleviate some of the side effects of cancer treatment or improve overall cancer survival.
High-quality placebo-controlled trials are needed to strengthen the present evidence base to support intravenous vitamin C/ascorbate being offered as a treatment by practitioners. There are currently no ongoing clinical trials listed on the EU clinical trials register investigating the use of vitamin C, ascorbic acid or ascorbate in oncology.
No intravenous vitamin C medicinal product has been granted a marketing authorisation in Ireland by Health Products Regulatory Authority, or the European Medicines Agency, other than general multi-vitamin products used in parenteral vitamin supplements.
It is open to a pharmaceutical company to submit an application for a marketing authorisation, for a medicinal product containing vitamin C, to place that product on the Irish market. However, such an application must be accompanied by a comprehensive dossier supporting the safety, quality and efficacy of that medicinal product for the indications sought.
951. Deputy John Brassil asked the Minister for Health the status of an appointment for a person (details supplied); and if he will make a statement on the matter. [19655/19]
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.
