Friday, 6 Sep 2019

Written Answers Nos. 945-970

Home Care Packages Administration

Ceisteanna (945)

Sean Fleming

Ceist:

945. Deputy Sean Fleming asked the Minister for Health his plans to place home support services on a statutory basis (details supplied); and if he will make a statement on the matter. [35446/19]

Freagraí scríofa

Minister of State at the Department of Health

Work is on-going to determine the optimal approach to the development of the statutory scheme within the broader context of the Sláintecare reforms. The Department’s Sláintecare Implementation Strategy commits to the introduction of the statutory scheme in 2021.

In 2019 work is focused on the design of the scheme and the options for regulation. As part of this work a review of the operation, management and funding of existing home support services is currently being undertaken.

Speech and Language Therapy Provision

Ceisteanna (946)

Sean Fleming

Ceist:

946. Deputy Sean Fleming asked the Minister for Health if he has considered the implications of not having the speech and language therapy on a statutory basis and the neglect that can arise to persons with a clear need; and if he will make a statement on the matter. [35447/19]

Freagraí scríofa

Minister of State at the Department of Health

The work to improve services for children with disabilities is focused on two key developments, the reorganisation and improvement of service delivery, and increased resources for therapy delivery.

The HSE is working with its partner organisations to implement ‘Progressing Disability Services for Children and Young People' Programme. The 'Progressing Disability Services ' programme is about forming partnerships between all the disability organisations in an area and pooling their staff with expertise in the different types of disabilities to form local Children’s Disability Network Teams who will provide services for all children with a disability, regardless of what their disability is or where they live or go to school.

I acknowledge that access to speech and language therapy intervention for children with disabilities is variable and that waiting lists in some parts of the country are unacceptably long. I also recognise the distress this can cause families and I want to emphasise that the provision of improved services for children with disabilities and additional needs remains a priority

As Minister for Disabilities, I want to ensure that children everywhere in the country will have access to the same timely and high quality services. Funding for an additional 100 therapy posts was secured as part of Budget 2019 in order to reduce waiting times for children for the Assessment of Needs process and also to improve access to therapy provision.

The HSE is actively drawing from panels across the various Community Healthcare Areas throughout the country with a view to filling these posts as soon as possible.

Because of the actions outlined above which I believe will deliver improved access to children's disability services including speech and language therapy intervention I do not consider it necessary to provide speech and language therapy services to children on a statutory basis.

Cross-Border Health Services Provision

Ceisteanna (947)

Sean Fleming

Ceist:

947. Deputy Sean Fleming asked the Minister for Health if a medical procedure that was carried out in a private clinic can be reimbursed (details supplied); and if he will make a statement on the matter. [35449/19]

Freagraí scríofa

Minister for Health

Where a person has met the terms of the Cross-Border Directive, and has received treatment in either a public or private institution of another EU\EEA Member State, they may seek reimbursement of the lesser of either the cost of such treatment in the Member State where it is received, or the cost that would have applied for the treatment in the public health system of their Member State of Affiliation. Reimbursement is not permitted where the treatment is received in the person's own Member State of Affiliation. Therefore, there is no reimbursement for procedures carried out in private hospitals in Ireland for Irish patients.

Speech and Language Therapy Provision

Ceisteanna (948)

Sean Fleming

Ceist:

948. Deputy Sean Fleming asked the Minister for Health his views on placing speech and language therapy services on a statutory basis as part of the early intervention service (details supplied); and if he will make a statement on the matter. [35467/19]

Freagraí scríofa

Minister of State at the Department of Health

The work to improve services for children with disabilities is focused on two key developments, the reorganisation and improvement of service delivery, and increased resources for therapy delivery.

The HSE is working with its partner organisations to implement ‘Progressing Disability Services for Children and Young People' Programme. The 'Progressing Disability Services ' programme is about forming partnerships between all the disability organisations in an area and pooling their staff with expertise in the different types of disabilities to form local Children’s Disability Network Teams who will provide services for all children with a disability, regardless of what their disability is or where they live or go to school.

I acknowledge that access to speech and language therapy intervention for children with disabilities is variable and that waiting lists in some parts of the country are unacceptably long. I also recognise the distress this can cause families and I want to emphasise that the provision of improved services for children with disabilities and additional needs remains a priority.

As Minister for Disabilities, I want to ensure that children everywhere in the country will have access to the same timely and high quality services. Funding for an additional 100 therapy posts was secured as part of Budget 2019 in order to reduce waiting times for children for the Assessment of Needs process and also to improve access to therapy provision.

The HSE is actively drawing from panels across the various Community Healthcare Areas throughout the country with a view to filling these posts as soon as possible.

Because of the actions outlined above which I believe will deliver improved access to children's disability services including speech and language therapy intervention I do not consider it necessary to provide speech and language therapy services to children on a statutory basis.

Services for People with Disabilities

Ceisteanna (949)

Mary Butler

Ceist:

949. Deputy Mary Butler asked the Minister for Health if approval will be given to allow a person (details supplied) who is wheelchair bound to avail of a bed or place locally; if so, when funding will be approved; and if he will make a statement on the matter. [35472/19]

Freagraí scríofa

Minister for 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.

Brexit Preparations

Ceisteanna (950, 951, 952, 956, 957, 959, 960, 1034)

John Brassil

Ceist:

950. Deputy John Brassil asked the Minister for Health the engagement his Department has undertaken since 25 July 2019 with the pharmaceutical and medical devices industries to adapt supply chains to minimise potential disruption; and if he will make a statement on the matter. [35474/19]

John Brassil

Ceist:

951. Deputy John Brassil asked the Minister for Health if monitoring to ensure that adequate stocks of medicines are routinely built into the medicine supply chain here has been increased since 25 July 2019; and if he will make a statement on the matter. [35475/19]

John Brassil

Ceist:

952. Deputy John Brassil asked the Minister for Health his views on whether a no-deal Brexit will not have an immediate impact on the supply of medicines; and if he will make a statement on the matter. [35476/19]

John Brassil

Ceist:

956. Deputy John Brassil asked the Minister for Health the further assessments that have taken place since 25 July 2019 of the extent to which Brexit may cause those with a small share of a particular medicine market to consider the ongoing viability of supply here; and the measures that have been put in place in relation to same. [35483/19]

John Brassil

Ceist:

957. Deputy John Brassil asked the Minister for Health the engagement his Department and the Health Products Regulatory Authority, HPRA, have had since 25 July 2019 with the European Commission to identify the most appropriate means to mitigate the risk to the supply of medical devices posed by a no-deal Brexit. [35485/19]

John Brassil

Ceist:

959. Deputy John Brassil asked the Minister for Health if monitoring to ensure that adequate stocks of medicines are routinely built into the medicine supply chain has been stepped up since 25 July 2019; and if he will make a statement on the matter. [35493/19]

John Brassil

Ceist:

960. Deputy John Brassil asked the Minister for Health the established multi-stakeholder procedures that are in place to anticipate and manage medicine shortages in the context of a no-deal Brexit. [35497/19]

Tony McLoughlin

Ceist:

1034. Deputy Tony McLoughlin asked the Minister for Health the amount of additional funding required to be provided to the HSE in order to enable it to continue the purchasing of a safe level of drugs and medicines for the health service since the decision of the United Kingdom to leave the European Union in 2016; the effects this decision has had on the ability of Ireland to purchase cheaper medicines globally; the measures being undertaken to ensure there is no major shortage of medicines here due to the UK's exit from the EU; if this will lead to larger budgets for the HSE to purchase drugs due to demand peaking in the UK; and if he will make a statement on the matter. [35792/19]

Freagraí scríofa

Minister for Health

I propose to take Questions Nos. 950 to 952, inclusive, 956, 957, 959, 960 and 1034 together.

As part of the whole-of-government response to Brexit, the Department of Health has established dedicated structures to manage the approach to preparing for the UK’s exit from the EU. The Department, the Health Products Regulatory Authority (HPRA) and the Health Service Executive (HSE), with the full support of stakeholders, are implementing a comprehensive and coordinated set of preparations to ensure continuity of health services and continued supply of medicines and medical devices in a ‘no deal’ Brexit.

Chapter 24 of the Government’s Contingency Action Plan for Brexit, updated in July 2019, details work underway in this area as outlined in https://www.dfa.ie/brexit/getting-ireland-brexit-ready/governmentcontingencyactionplan/

The preparations include developing contingency plans to mitigate potential supply problems arising from Brexit. The Department, the HSE and the HPRA have facilitated ongoing engagements with manufacturers and suppliers of medicines and medical devices, to ensure that they are Brexit-ready, to discuss any potential issues that could affect supply to Ireland and to identify solutions to maintain supply to the market.

As a result of measures undertaken at industry, national and EU level, Brexit is not expected to have an immediate impact on the supply of medicines in Ireland. Pharmaceutical manufacturers and wholesalers have provided assurances that there will be sufficient stocks to bridge any initial issues at ports, should they occur. However, given the size of our market, Brexit may cause those with a small share of a particular medicine market to consider the ongoing viability of supply to Ireland. However, it is considered that any such products are unlikely to be critical to continuity of care, as there are and will be alternative suppliers or therapeutic alternatives available.

Medicine shortages are a feature of modern health systems, but Ireland has a multi-stakeholder system in place to prevent and manage shortages when they occur. Any shortages currently affecting the Irish market are not directly attributable to Brexit.

The HPRA has worked with stakeholders, including the HSE, to develop an effective approach to the management of medicine shortages in Ireland. In 2018 the HPRA launched the “Medicine Shortages Framework”, which is built in a pragmatic and collaborative approach involving the wide range of stakeholders within the medicine supply chain. The HPRA coordinates all stakeholders to share information in order to prevent or mitigate the impact of 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, consideration continues to be given to those categories of medicines which are considered most essential to public health. The HSE and HPRA are continuing to undertake criticality assessments, seeking additional and updated assurances from stakeholders, including pharmaceutical manufacturers, wholesalers and healthcare professionals, to verify contingency planning to date and, where necessary, identify clinically appropriate alternatives for those products most critical to public health with potential to be vulnerable to supply issues.

Manufacturers and suppliers of medicines and medical devices have been asked to further review their supply chain for products that travel from or through the UK, determine any products or services that are certified for compliance with EU standards by a UK body and communicate any potential vulnerabilities to the Department of Health, HPRA or HSE.

Work on this will continue up to, and in the months following, Brexit. This will include ongoing monitoring of supplies in Ireland and engagement with industry to adapt supply chains, where necessary, to minimise any potential disruption.

The Department of Health and the HPRA will also continue to engage with the European Commission, the Brexit Preparedness Group and Task Force 50 to identify the most appropriate means to mitigate any remaining risks to the supply of medicines and medical devices posed by a no-deal Brexit. However, it remains vital that industry continues to prepare for a no-deal Brexit.

It is important to note that there are already additional stocks of medicines and medical devices routinely built into the Irish medicine supply chain. This is a different supply model to that which operates in the UK. The pharmaceutical industry and wholesalers have provided assurance that they are confident they will have sufficient stocks to bridge any initial issues at ports, should they occur. The key message to emphasise to citizens and patients is that there is no need for hospitals, pharmacists or patients to order extra quantities of medicines, or for doctors to issue additional prescriptions, as doing so could disrupt existing stock levels and hamper the supply of medicines for other patients.

Hospital Appointments Status

Ceisteanna (953)

Mary Butler

Ceist:

953. Deputy Mary Butler asked the Minister for Health when a person (details supplied) will be called for an operation at University Hospital Waterford; and if he will make a statement on the matter. [35477/19]

Freagraí scríofa

Minister for Health

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.

Cross-Border Health Services Provision

Ceisteanna (954)

Pearse Doherty

Ceist:

954. Deputy Pearse Doherty asked the Minister for Health when a person (details supplied) in County Donegal can expect to be reimbursed for treatment carried out under the cross border directive; and if he will make a statement on the matter. [35478/19]

Freagraí scríofa

Minister for Health

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

Brexit Preparations

Ceisteanna (955)

John Brassil

Ceist:

955. Deputy John Brassil asked the Minister for Health the number of times the Brexit operations team in his Department has met since 25 July 2019. [35482/19]

Freagraí scríofa

Minister for Health

The Government published the Brexit Contingency Action Plan Update in July, reflecting the extensive work which has taken place at EU level and on a whole-of-Government basis, to prepare for a no deal Brexit, and setting out the steps to be taken between now and 31 October.

The Department of Health, in conjunction with the Health Service Executive (HSE), the Health Products Regulatory Authority (HPRA) and the Food Safety Authority of Ireland (FSAI) has been engaged in extensive Brexit planning and action to ensure that the health sector is prepared, to the greatest extent possible, for any adverse impacts as a result of Brexit.

As part of the whole-of-government response to Brexit, the Department of Health has established dedicated structures to manage the approach to preparing for the UK’s exit from the EU. From an early stage, Brexit has been regularly discussed at Management Board Level within the Department including Ministerial Management Board meetings. A Management Board Subcommittee on Brexit was established to review the Department's preparedness.

A high-level group chaired by the Secretary General and comprising the heads of the HSE, HPRA, FSAI and senior officials was established to ensure alignment, cooperation and focus on Brexit preparedness and contingency planning across the health sector. Since January, this group has meet frequently to review progress at a high level, to consider the on-going political uncertainties in the UK and to provide direction to the Brexit Operations Team.

The Operations Team chaired by a Deputy Secretary General and comprising of senior officials from the Department of Health, the HSE, HPRA and the FSAI was established to identify and resolve issues and to escalate them to the high-level group if necessary. The Team provides a strategic focus on the Department and the Health Sector’s preparations for Brexit, through providing a joined-up approach to Brexit related tasks, building on significant work done to date, providing a central point for agencies to contribute, and feed into central Government’s coordinated response as well as coordinating liaison with health stakeholders and developing communication strategies for the health sector. The team focus is on implementing mitigating measures drawing on expertise from across the Department and the sector.

The Department's Brexit Operations Team has met 23 times since the start of January, including three times over the short period referred to by the Deputy. Collaboration on individual tasks arising is dealt with on an on-going basis.

The Brexit Operations Team has also established two work streams to identify critical medicines and medical devices that may be vulnerable to supply distribution as a result of Brexit. These work streams are undertaking criticality assessment exercises on potentially vulnerable medicines and medical devices and focusing their contingency planning efforts accordingly. They comprise officials from the Department, the HSE and the HPRA.

Officials from the Department have also participated fully in a range of interdepartmental groups established to support preparations for Brexit including the Secretary Generals' Group, the Assistant Secretaries’ Group, and the Senior Official Group on Legislation, the Brexit Coordinators' Group and the Brexit Communications' Group. The Department has also attended meetings with the EU Commission on Brexit.

Questions Nos. 956 and 957 answered with Question No. 950.

Hospital Appointments Status

Ceisteanna (958)

Niamh Smyth

Ceist:

958. Deputy Niamh Smyth asked the Minister for Health if an urgent appointment for surgery for a person (details supplied) will be expedited; and if he will make a statement on the matter. [35486/19]

Freagraí scríofa

Minister for Health

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.

Questions Nos. 959 and 960 answered with Question No. 950.

Services for People with Disabilities

Ceisteanna (961)

Richard Boyd Barrett

Ceist:

961. Deputy Richard Boyd Barrett asked the Minister for Health his plans to reverse his decision to abolish the rehabilitative training allowance from 1 September 2019 for persons with disabilities that are applying to do a rehabilitative training programme in 2019; and if he will make a statement on the matter. [35500/19]

Freagraí scríofa

Minister of State at the Department of Health

This 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. The 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 payment of the Rehabilitative Training (RT) Bonus came into place on the transition of Rehabilitative / Training Programmes to the HSE following the dissolution of the National Rehabilitation Board in June 2000.

The decision to phase out the Rehabilitative Training (RT) Bonus payment is designed to bring equity and consistency between people with a disability attending HSE funded rehabilitative training programmes who receive the payment, and those attending similar HSE funded Day Services or in other State schemes such as further education and training, who do not.

This action will ensure all HSE funded Day Services are provided on an equitable basis and will also ensure that the use of finite resources is maximised.

The Rehabilitative Training (RT) Bonus Payment is a historical payment, introduced in July 2001, aligned with a similar FÁS Training Bonus. However, during 2011 the FÁS Training Bonus was reduced to €20.00 and then eliminated the following year while to date the RT Bonus Payment has continued to be paid in the Health Sector

It is worth remembering that:

- There is no cut in the number of RT places available

- There is no cut in payment of the bonus - those who have it will continue to receive it for the remainder of their RT Placement

- All participants continue to be eligible for Disability Allowance of €203 per week

- All participants continue to be eligible for a free travel pass

- No expectation of an additional RT bonus payment has been created by HSE for 2019 participants

The redirected funding (€3.7 m over 4 years), which will be ring-fenced, will facilitate 148 full day placements or 370 enhanced day places nationally based on priority need.

Each CHO will have the flexibility to redirect its own savings to address local service requirements. The HSE will put in place a monitoring system and regularly report the additional placements realised to the Department of Health.

Hospital Appointments Status

Ceisteanna (962)

Richard Boyd Barrett

Ceist:

962. Deputy Richard Boyd Barrett asked the Minister for Health the way in which a person (details supplied) can access treatment they require. [35503/19]

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 directly to the Deputy as soon as possible.

Services for People with Disabilities

Ceisteanna (963)

Mary Butler

Ceist:

963. Deputy Mary Butler asked the Minister for Health if approval will be given to allow a person (details supplied) with an intellectual disability return to support and respite services locally; if so, when the funding will be approved; and if he will make a statement on the matter. [35510/19]

Freagraí scríofa

Minister of State at the Department of 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 an individual case, I have arranged for the question to be referred to the Health Service Executive (HSE) for direct reply to the Deputy.

Health Services

Ceisteanna (964, 965, 966, 967, 968, 969, 970)

Tom Neville

Ceist:

964. Deputy Tom Neville asked the Minister for Health his plans to address the lack of specialist consultants for myalgic encephalomyelitis, ME, patients; and his views on whether ME is a multi-system disease involving many areas with many debilitating symptoms which require patients to see many consultants and incur large costs. [35519/19]

Tom Neville

Ceist:

965. Deputy Tom Neville asked the Minister for Health if the HSE will be instructed to develop a clear pathway of care for ME patients with prompt access to specialists and treatments. [35520/19]

Tom Neville

Ceist:

966. Deputy Tom Neville asked the Minister for Health if he will designate ME as a reportable health condition in order to obtain robust official collection of data on the number of children, young persons and adults with the condition and the degrees of severity of the condition; and if he will make a statement on the matter. [35521/19]

Tom Neville

Ceist:

967. Deputy Tom Neville asked the Minister for Health the criteria used here to diagnose ME as described under G.93.3 WHO International classification of diseases, 10th provision (ICD/10); and if he will make a statement on the matter. [35523/19]

Tom Neville

Ceist:

968. Deputy Tom Neville asked the Minister for Health if he will request the HSE to develop guidelines for ME relevant to Ireland; and if contemporary research will be referenced rather than leaving it to the United Kingdom. [35524/19]

Tom Neville

Ceist:

969. Deputy Tom Neville asked the Minister for Health if the HSE will be requested to commence implementing the international consensus criteria for ME in order that persons with the condition can receive a clear diagnosis as quickly as possible. [35525/19]

Tom Neville

Ceist:

970. Deputy Tom Neville asked the Minister for Health if the HSE will update its diagnostic and treatment procedures for persons suffering with ME to reflect best international practice; if the lack of specialist support within the HSE will be addressed for those with the condition; and if he will make a statement on the matter. [35526/19]

Freagraí scríofa

Minister for Health

I propose to take Questions Nos. 964 to 970, inclusive, together.

Chronic fatigue syndrome (CFS) / myalgic encephalomyelitis (or encephalopathy) (ME) is a complex debilitating disorder which is characterised by severe fatigue accompanied by a range of other symptoms.

There is currently no known, specific, medical diagnostic test to determine or confirm a correct diagnosis of ME and no specific treatment which works for all sufferers is currently available. As a result clinical assessment and the design of care plans need to be tailored to the individual patient. There are assessments and tests which can be carried out in primary care settings by a General Practitioner. Specialised tests may be required when considering and ruling out other diagnoses.

Treatment for ME is tailored to address the varying symptoms presented by those affected by ME. In general, these treatments are delivered within the context of primary care, with referrals into secondary care for specialist interventions in the areas of Neurology, Rheumatology, Pain Specialists, Endocrinology, Immunology, Cardiology, etc. Different patients, depending on their primary symptoms, will require different Consultant input. The challenge in relation to ME is that it does not sit within one specialty, but crosses a number of specialties, with patients frequently attending different Consultants for management of their symptoms as and when they arise. Consultants are well used to coordinating the care of patients that require the input of their colleagues and other members of the multidisciplinary care team.

In order to allow for the timely access to services for patients, work is under way as part of the implementation of the Strategy for the Design of Integrated Outpatient Services 2016-2020, specifically as regards addressing how and where the patient is treated and the classification of referrals with corresponding clinically recommended time-frames. Consideration is also being given to condition specific referral forms. This work should see significant improvements with respect to access to appropriate services.

There are two general categories of disease as “reportable health conditions” – Infectious Diseases and Cancer. There are no plans to add this condition to the list. However, any patient is eligible to apply to the Drugs Payment Scheme or to apply for a Medical Card. In addition, under the Drug Payment Scheme, no individual or family pays more than €124 a month towards the cost of approved prescribed medicines. The scheme significantly reduces the cost burden for families and individuals with ongoing expenditure on medicines.

People who cannot, without undue hardship, arrange for the provision of medical services for themselves and their dependants may be entitled to a medical card or other state financial supports. In the assessment process, the HSE can take into account medical costs incurred by an individual or a family.

People not eligible for a medical card may still be able to avail of a GP visit card, that covers the cost of GP consultations.

The Canadian Consensus Guideline outlines that for consideration of a diagnosis of ME, a person should have a number of symptoms. There are assessments/tests that can be carried out in primary care setting by the General Practitioner. Specialised tests may be required when considering differential diagnoses.

The Health Service Executive does not rely entirely on research from the UK for this or any other condition. Every effort is made to access relevant evidence based research as it becomes available. The HSE prioritises the development of guidelines based clinical need and in the context of available resources.

I have asked the HSE to consider the service matters raised by the Deputy and to respond directly to him.