Written Answers Nos. 405-424
405. Deputy Aindrias Moynihan asked the Minister for Health the start date for the new endocrinologist for the paediatric diabetes service in Cork University Hospital; and if he will make a statement on the matter. [39785/19]
Amharc ar fhreagraAs this is a service matter, I have asked the Health Service Executive to respond to you directly as soon as possible.
406. Deputy Aindrias Moynihan asked the Minister for Health the management plans in place to help teenage patients transition into adult diabetes services at Cork University Hospital; and if he will make a statement on the matter. [39786/19]
Amharc ar fhreagraAs this is a service matter, I have asked the Health Service Executive to respond to you directly as soon as possible.
407. Deputy Bríd Smith asked the Minister for Health the amount spent to date on providing free contraceptives as promised during the referendum on the Eighth Amendment of the Constitution; the quantity and type of contraceptive purchased for a free contraceptive scheme; and the location in which persons can access these free contraceptives. [39791/19]
Amharc ar fhreagraApproximately one-third of the population hold a medical card, and these individuals can access contraception from their GP free of charge except for a small per item prescription charge levied at the pharmacy. The Primary Care Reimbursement Service (PCRS) have reported that 124,379 clients availed of contraceptive drugs and special services through the GMS scheme in 2018. The cost of delivering this service was approximately €11.45m. The scheme includes most types of contraception, including Long Acting Reversible Contraception, although condoms and the copper coil are not covered.
The National Condom Distribution Service (NCDS), which was established in 2015, distributes free condoms and lubricant sachets to HSE services and other organisations working directly with individuals and groups who may be at increased risk of negative sexual health outcomes.
A variety of services and organisations typically order condoms and/or lubricant sachets from the NCDS. These include statutory services, non-governmental organisations (NGOs) or community organisations, student unions and student health centres. The NCDS also provides condoms and lubricant sachets to support sexual health promotional campaigns and educational initiatives. In 2018, figures indicate that 409,319 condoms and 287,565 lubricant sachets were delivered through the NCDS. Data provided by the HSE show that €35,243 was spent on condoms in 2018.
The Deputy may also wish to note that the Minister has established a Working Group to examine the various policy, regulatory and legislative issues arising in relation to improving access to contraception.
408. Deputy Kevin O'Keeffe asked the Minister for Health when a HSE service (details supplied) will reopen. [39794/19]
Amharc ar fhreagraAs the Health Service Executive is responsible for the delivery of public healthcare services and infrastructure projects, I have asked the HSE to respond to you directly in relation to this matter.
409. Deputy Tony McLoughlin asked the Minister for Health if his attention has been drawn to the financial difficulties which the six members of voluntary hospital groups currently find themselves in providing palliative care services in view of the difficulties experienced operating as section 39 organisations whilst also implementing the increases of the most recent pay deal; if this issue will be given consideration; and if he will make a statement on the matter. [39797/19]
Amharc ar fhreagraI understand that the HSE is monitoring, on an ongoing basis, the financial position of voluntary hospices who are funded under service level agreements. The current service level agreement process provides a forum for hospices to discuss any issues or difficulties with the Chief Officer of the relevant Community Healthcare Organisation.
In the HSE's 2019 National Service Plan, an additional €2 million was provided for specialist palliative care services, with €1m allocated to both Marymount Hospice and St. Francis Hospice to support sustainable services in line with agreed plans.
In accordance with a recommendation in the HSE's Palliative Care Services Three Year Development Framework 2017-2019, the HSE has established a working group to examine what constitutes a core specialist palliative care service, including both pay and non-pay costs, with a view to achieving full statutory funding of core services. The report of this Group is not yet finalised.
The level of funding available for palliative care services in 2020 will be considered in the context of the estimates and budgetary process, and national service planning.
410. Deputy Niamh Smyth asked the Minister for Health the status of the orthodontic appointment referral for a person (details supplied); and if he will make a statement on the matter. [39805/19]
Amharc ar fhreagraAs this is a service matter it has been referred to the HSE for reply to the Deputy.
411. Deputy Gino Kenny asked the Minister for Health the commencement dates of the medical cannabis access programme; and when the first patients will be referred to the pilot programme. [39807/19]
Amharc ar fhreagraOn 26th June I signed legislation which will allow for the operation of the Medical Cannabis Access Programme (MCAP) on a pilot basis for five years.
This new legislation means that commercial medical cannabis suppliers whose cannabis products meet the specified requirements set out in the legislation and which have been listed in Schedule 1 of the Misuse of Drugs (Prescription and Control of Supply of Cannabis for Medical Use) Regulations will be able to supply these products to the Irish market.
Once suitable medical cannabis products are made available by suppliers, the Access Programme will make it possible for a medical consultant to prescribe, in line with the published clinical guidance, a listed cannabis-based product for a patient under his or her care for the following medical conditions, where the patient has failed to respond to standard treatments:
- spasticity associated with multiple sclerosis;
- intractable nausea and vomiting associated with chemotherapy;
- severe, refractory (treatment-resistant) epilepsy.
It should be noted that currently no medical cannabis products are available for use under the MCAP as it is expected that it will take some time for suppliers to arrange to have their products made available on the Irish Market.
However I am pleased to say that there are a number of suppliers who have already expressed interest.
The medical decision to prescribe or not prescribe any treatment, including cannabis treatment, for an individual patient is strictly a decision for the treating clinician, in consultation with their patient. The Minister for Health has no role in this clinical decision-making process.
Pending full operation of the MCAP, and for medical indications not included in the MCAP, doctors may continue to utilise the Ministerial licencing route to prescribe medical cannabis for their patients, should they wish to do so. 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.
412. Deputy Michael Healy-Rae asked the Minister for Health if he will address a matter (details supplied) regarding women's sexual health; and if he will make a statement on the matter. [39809/19]
Amharc ar fhreagraWhile it should be noted that GPs already provide the services referred to by the Deputy in the normal course of their work, there is also wider policy work ongoing to support improved sexual health and wellbeing in women.
Women’s health is a priority for my Department. I was pleased to hold the first meeting of the newly established Women’s Health Task Force on the 26 of September.
The Task Force will examine a wide range of issues impacting women’s health outcomes in Ireland and to work on these on a phased, prioritised basis. As its first action, the Taskforce will lead a large-scale consultation with women in Ireland to hear their experiences of and solutions for the health system.
Good progress has been made in the area of sexual health. The National Sexual Health Strategy 2015-2020 was launched in October 2015. The Strategy’s key aims are to improve sexual health and wellbeing and to reduce negative sexual health outcomes. A mid-term review of the Strategy, conducted in 2018, found that implementation is going well and that the Strategy will remain relevant beyond 2020.
Consequently, the vision for the strategy, priorities and actions post 2020 will be reviewed to ensure the programme evolves in line with the changes to the external environment and the opportunities these may bring. A refreshed version of the strategy will be developed in 2020.
The Ancillary Recommendations of the Committee on the 8th Amendment to the Constitution are a key implementation priority. Funding of €500,000 has been provided to the HSE Sexual Health and Crisis Pregnancy Programme to support implementation of the Recommendations. Measures include the expansion of condom provision, actions related to education and training, work arising from recommendations of the NCCA review of Relationship and Sexuality Education, communications campaigns, the MyOptions support service for those facing unplanned pregnancy, and development of a general population survey on sexual health.
A Working Group has been established within the Department of Health to examine the various policy, regulatory and legislative issues arising in relation to improving access to contraception. The Group has recently held a public consultation exercise and has engaged directly with numerous stakeholders. It is currently preparing a report which I expect to receive shortly.
A policy review of sexual assault treatment units (SATUs) has recently been conducted, which has put forward a number of practical actions to enhance and strengthen the Health response to victims of sexual violence.
One of the Review's actions is to communicate the role and support available through SATUs more routinely and effectively. The HSE is currently working on a SATU specific communications project - one aspect of which will be to improve knowledge and education about SATU services among, clinicians across the health service, and wider society.
A sub-Committee of the National Strategy for Women and Girls (NSWG) Strategy Committee has been established to examine issues around period poverty. The sub-Committee is chaired by my Department and includes representation from a number of Government Departments and NGOs, including the National Women's Council of Ireland. The first meeting of the sub-Committee took place on September 6.
413. Deputy Michael Healy-Rae asked the Minister for Health if hospital capacity will be increased (details supplied); and if he will make a statement on the matter. [39810/19]
Amharc ar fhreagraI wish to acknowledge the distress overcrowded Emergency Departments cause to patients, their families, and frontline staff working in very challenging conditions in hospitals throughout the country.
The Health Service Capacity Review published last year was clear on the need for a major investment in additional capacity in both hospital and community – combined with a wide scale reform of the manner and the location of where health services are provided.
Increasing capacity alone will not address the challenges faced, but on the basis of significant reform over the next 10-15 years, the report recommends an additional 2,600 acute beds by 2031. The National Development Plan provides for the full complement of beds by 2028 - 3 years ahead of schedule.
Since 2017, an additional 267 beds have been opened. The Capacity Programme for 2019 provides for the following increases in capacity, as set out in the National Service Plan 2019:
- The provision of 75 acute beds and 70 community beds under the Winter Plan 2018/19 – the HSE has confirmed that all the acute beds and 59 community beds have opened to date.
- 47 additional beds, including the 40-bed modular build in South Tipperary General Hospital (STGH), 3 HDU beds in the Mater Hospital and 4 HDU beds in Cork University Hospital.
- preparation of 202 beds, of which 16 are critical care, during 2019, with a view to bringing this extra capacity into operation in the first quarter of 2020.
- Commencement of works on a 60-bed modular ward in University Hospital Limerick.
Improving timely access for patients is at the heart of Sláintecare. Building upon the progress made in recent years in this area, the Sláintecare Action Plan 2019 published by the Department, includes a specific work stream on Access and Waiting Lists. In addition, many of the other service reforms and enhancements included in the Action Plan will support timely access to care for patients in the coming years. Progress has already been made in implementing the Sláintecare Action Plan’s Access actions this year.
415. Deputy Thomas Byrne asked the Minister for Health if the HPV vaccination which is already available for girls born in 2004 will become available for boys born in 2004. [39816/19]
Amharc ar fhreagraThe immunisation programme in Ireland is based on the advice of the National Immunisation Advisory Committee (NIAC). The committee's recommendations are based on the prevalence of the relevant disease in Ireland and international best practice in relation to immunisation. It makes recommendations on vaccination policy to my Department. NIAC continues to revise recommendations to allow for the introduction of new vaccines in Ireland and to keep abreast of changes in the patterns of disease. Therefore, the immunisation schedule will continue to be amended over time.
In 2009 the NIAC recommended HPV (human papillomavirus) vaccination for all 12-13 year old girls to reduce their risk of developing cervical cancer when they are adults. In September 2010 the HPV vaccination programme was introduced for all girls in first year of secondary school. Gardasil is the vaccine used by the HSE in the School Immunisation Programme and is provided free of charge to girls in secondary school.
The National Immunisation Advisory Committee (NIAC) made a recommendation that the HPV vaccine should be given to boys. On foot of NIAC’s recommendation, my Department asked the Health Information and Quality Authority (HIQA) to undertake a health technology assessment (HTA) to establish the clinical and cost-effectiveness of extending the current immunisation programme, which offers HPV vaccination to all girls in their first year of second level education (generally 12 to 13 year olds), to a programme that also offers the vaccination to boys in their first year of secondary school.
HIQA completed the HTA in December 2018, recommending that the HPV immunisation programme be extended to include boys. A policy decision was made to extend the HPV immunisation programme to include boys starting in September 2019 with the introduction of a 9-valent HPV vaccine. However, the HIQA report published in December 2018 did not recommend an HPV catch-up programme for older boys for several reasons:
- accinating boys in the first year of secondary school provides the best possible protection against HPV infection;
- Boys are already benefitting from the indirect herd protection provided by the girls' HPV vaccination programme which started in 2010.
During the 2019/20 school year, girls who previously declined the HPV vaccine and are still attending secondary school can join the HPV girls only programme. By contacting your local HSE Health Office appointments will be offered to girls to receive the HPV vaccine in HSE mop up clinics. However, it must be noted that vaccinated girls may still be at risk from other high risk types of HPV that can cause cervical cancer and will therefore need to continue to have regular cervical smear tests.
For older children who did not receive the vaccine as part of the School Immunisation Programme the HPV vaccine can only be obtained privately from a GP. If your child is 15 years of age or older they will require three doses of the HPV vaccine in order to be fully protected. Those who have a medical card are eligible to have the vaccine administered free of charge by their GP. However, the cost of purchasing the vaccine privately is not covered by the medical card.
The ages at which vaccines are recommended in the immunisation schedule are chosen by NIAC in order to give each child the best possible protection against vaccine preventable diseases. As the HPV vaccine is preventative it is intended to be administered, if possible, before a person becomes sexually active, that is, before a person is first exposed to HPV infection. Therefore, the gender neutral HPV vaccination programme targets all girls and boys in first year of secondary school to provide maximum coverage. All vaccines administered through the School Immunisation Programme are provided free of charge.
My Department will continue to be guided by NIAC's recommendations on any emerging evidence on this issue in the future.
416. Deputy Niamh Smyth asked the Minister for Health the conditions which are eligible for the long-term illness scheme; his plans to review the scheme with a view to adding more conditions to same; and if he will make a statement on the matter. [39820/19]
Amharc ar fhreagra417. Deputy Niamh Smyth asked the Minister for Health the reason Crohn's disease is not eligible for the long-term illness scheme; his plans to review the scheme with a view to adding more conditions to same; and if he will make a statement on the matter. [39821/19]
Amharc ar fhreagraI propose to take Questions Nos. 416 and 417 together.
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 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 the LTI Scheme will 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.
For people who are not eligible for the LTI Scheme, there are other arrangements which protect them from excessive medicine costs.
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. In the assessment process, the HSE can take into account medical costs incurred by an individual or a family.
People who are not eligible for a medical card may still be able to avail of a GP visit card, which covers the cost of GP consultations.
419. Deputy Marcella Corcoran Kennedy asked the Minister for Health when he plans to meet a group (details supplied) which was promised at the last meeting with the group in March 2019; and if he will make a statement on the matter. [39861/19]
Amharc ar fhreagraAs 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 was published on the Department of Health website on 21 November 2018.
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 2018 to pause all mesh procedures where clinically safe to do so, pending confirmation by the HSE of the implementation of recommendations relating to (i) professional training requirements, (ii) patient information and consent and (iii) the development and maintenance of a national data set for all mesh procedures carried out in HSE funded hospitals.
A Synthetic Mesh Devices Advisory Group was convened by the HSE, to advise on and progress all of the recommendations which included 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.
I am informed that an ongoing work programme for the clarification and development of treatment pathways and appropriate referral services for women suffering from mesh-related complications is being progressed by the HSE. This work includes 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 work, the HSE is also examining options to address service requirements for patients with immediate or urgent needs.
As was requested by the Secretary General of my Department in November 2018, the HSE has prepared an Implementation Plan for the complete set of recommendations set out in the CMO’s Report, which was approved by the Leadership Team in the HSE and published on the HSE website on 26 April 2019, which I hope provides further clarity on this issue.
I am informed that the HSE has advised that a detailed progress report on implementation of the recommendations will be provided to my Department and this report is awaited.
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.
I would strongly encourage all women affected by mesh to engage with the relevant HSE contact points provided, to ensure that their service needs can be identified and provided for.
At my 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. It is my intention to meet again with the Mesh Survivors Ireland group in the coming weeks.
420. Deputy John Curran asked the Minister for Health the steps he is taking to address issues raised in a new report by an organisation (details supplied) into supports for children through the Irish refugee protection programme and reports by numerous stakeholders that children have considerable oral health needs but that there are challenges in accessing appropriate services; and if he will make a statement on the matter. [39870/19]
Amharc ar fhreagraAs this is a service matter, it has been referred to the Health Service Executive for attention and direct reply to the Deputy.
421. Deputy John Curran asked the Minister for Health further to Parliamentary Question No. 1304 of 6 September 2019, if he is satisfied that 363 persons waited over a month to be discharged from hospital and 79 persons who were ready to be discharged have waited over six months in hospital to be discharged; and if he will make a statement on the matter. [39872/19]
Amharc ar fhreagraDelayed transfers of care (previously referred to as delayed discharges) occur when patients have been deemed clinically fit for discharge from an acute bed but whose discharge is delayed because they are waiting for some form of on-going support or care following their discharge. There are many reasons for this, such as a patient undertaking the application process for NHSS, awaiting assessment for a home care package, homelessness, ward of court application, and the availability of resources.
In many cases, the HSE will use transitional care to accommodate the patient during the period between discharge, and the finalisation of the new care arrangements, but can often be a delay, especially in cases where the patient and family are coming to terms with the new circumstances.
The HSE seeks to balance patient experience with the need to keep DTOCs as low as possible.
This year, services are being stretched more than ever, with demand consistently outstripping supply and we have seen increases in delayed transfers of care. While the HSE maximises the use of resources, prioritising those requiring discharge from acute hospitals, there is a growing demand for egress support and in response, and in the context of planning and preparing for the challenges of the winter period, the Department and the HSE have been considering a comprehensive approach to the current the high-level of DTOCs. However, recognising the urgency of the situation, approval was provided to the HSE to begin actions immediately to the value of €5m in 2019. As part of these measures the HSE released a significant number of funding approvals within NHSS this month, bringing the waiting time for the release of funding back to 4 weeks, and provided additional home care and transitional care beds.
Separately, following the 2019 publication of the Independent Expert Review of Delayed Discharges, an implementation group has been established to progress the recommendations. Minister Daly has also established a Cross Divisional Oversight Group within the Department of Health to oversee the HSE’s implementation of the recommendations.
As regards those persons discharged and awaiting new care arrangements for over 6 months, the Department does not have specific details on these individuals, but generally these cases are complex, and include issues such as homelessness, legal issues (such as ward of court) and the requirement for modifications to be undertaken at the patients home before they can leave hospital.
The Department will seek further information and provide a further response directly to the Deputy.
422. Deputy Michael Harty asked the Minister for Health when the HTA review team will make a decision on extending the availability of FreeStyle Libre to all type 1 diabetic patients irrespective of age; and if he will make a statement on the matter. [39874/19]
Amharc ar fhreagraUnder the Health (Pricing and Supply of Medical Goods) Act 2013, the HSE has statutory responsibility for the administration of the community drug schemes; therefore, the matter has been referred to the HSE for attention and direct reply to the Deputy.
423. Deputy Michael McGrath asked the Minister for Health the differences in the way in which different pension products and funds are assessed, both in terms of income and capital, as part of the financial assessment of an application under the nursing home support scheme, with particular regard to the treatment of an approved retirement fund, a private annuity pension or a public service pension; his plans to make changes in this area; and if he will make a statement on the matter. [39875/19]
Amharc ar fhreagraThe Nursing Homes Support Scheme (NHSS), commonly referred to as A Fair Deal, is a system of financial support for those in need of long-term nursing home care. Participants contribute to the cost of their care according to their income and assets while the State pays the balance of the cost.
The Scheme aims to ensure that long-term nursing home care is accessible and affordable for everyone and that people are cared for in the most appropriate settings. An applicant to the scheme can choose any public, voluntary or approved private nursing home. The home must have availability and be able to cater for the applicant's particular needs.
Participants in the Scheme contribute up to 80% of their assessable income and a maximum of 7.5% per annum of the value of assets held. In the case of a couple, the applicant’s means are assessed as 50% of the couple’s combined income and assets. The first €36,000 of an individual’s assets, or €72,000 in the case of a couple, is not counted at all in the financial assessment. The capital value of an individual’s principal private residence is only included in the financial assessment for the first three years of their time in care. This is known as the three year cap.
The Scheme has a number of important safeguards built into the financial assessment which ensures that:
- Nobody will pay more than the actual cost of care;
- An applicant will keep a personal allowance of 20% of his/her income or 20% of the maximum rate of the State Pension (non-Contributory), whichever is greater. This is in recognition of the fact that, although the NHSS covers core living expenses, residents can still incur some costs in a nursing home, such as social programmes, newspapers or hairdressing;
- If an applicant has a spouse/partner remaining at home, he/she will be left with 50% of the couple’s income or the maximum rate of the State Pension (non-Contributory), whichever is greater;
- If both members of a couple enter nursing home care, they each retain at least 20% of their income, or 20% of the maximum rate of the State Pension (non-Contributory), whichever is greater;
- Certain items of expenditure, called allowable deductions, can be taken into account for the financial assessment, including health expenses, payments required by law, rent payments and borrowings in respect of a person’s principal private residence;
- A person’s eligibility for other schemes, such as the Medical Card Scheme or the Drug Payment Scheme, is unaffected by participation in the Nursing Homes Support Scheme or residence in a nursing home.
Income from public, private or State pensions are treated in the same manner as other sources of income having regard for the fact that the Scheme is a financial support scheme with the level of State support provided dependent on the financial means of the applicant. There are no plans to make changes to how pensions are assessed under the NHSS.
424. Deputy Michael Collins asked the Minister for Health when the more than 90 type 1 diabetes young adults and teenagers attending Cork University Hospital will be transitioned form the paediatric diabetes services to the adult diabetes services; and if he will make a statement on the matter. [39881/19]
Amharc ar fhreagraAs this is a service matter, I have asked the Health Service Executive to respond to you directly as soon as possible.
