Written Answers Nos. 279-303
279. Deputy John Lahart asked the Minister for Health the reason persons with multiple sclerosis have access to new medicines within weeks or months in many European countries but patients here can wait over four years for new medicines to be made available (details supplied); the reason for slower approval for new medicines here; the steps he is taking to ensure access is expedited; and the date same will be achieved. [48648/19]
Amharc ar fhreagraThe HSE has statutory responsibility for medicine pricing and reimbursement decisions, under the Health (Pricing and Supply of Medical Goods) Act 2013. The Act specifies criteria for decisions on the reimbursement of medicines.
HSE decisions on which medicines are reimbursed by the taxpayer are made on objective, scientific and economic grounds, on the advice of the National Centre for Pharmacoeconomics (NCPE). The NCPE conducts health technology assessments (HTAs) for the HSE and makes recommendations on reimbursement to assist HSE decisions
As a country, we invest heavily in medicines, to the tune of almost €2 billion annually. As of October 2019, there have been 29 new medicines and 5 new indications for existing medicines approved for reimbursement in the public healthcare system. The approvals to date represent an additional investment by the HSE over five years of approximately €220m in providing access to new and innovative treatment for Irish patients. It is expected that over 3,000 patients will benefit from access to these new medicines over the next 5 years
Notwithstanding the significant progress on drug costs achieved from price reductions under the pricing framework agreed with industry and commercial negotiations conducted by the HSE, the Health Service is still facing very significant challenges in relation to the affordability of medicines. The industry continues to develop very expensive products, particularly in the high-tech medicines area and the costs involved are a challenge for health systems even in countries with much greater resources than Ireland.
The Government wants new and innovative medicines to be available to our citizens as quickly as possible, but this can only be achieved if medicines are priced by the pharmaceutical industry in a viable and sustainable manner. "League tables" comparing speed of reimbursement in Ireland with that of other countries are often misleading since several countries have quite different and often less rigorous assessment arrangements than Ireland. Furthermore, many of the newer products being licenced are falling well short of cost-effectiveness thresholds, with limited clinical benefits.
The current process for assessing applications works very well where the new medicines have strong evidence of clinical effectiveness and are priced in a cost-effective manner. Delays in reimbursement decisions for new products do occur in cases where the evidence of clinical effectiveness is weak, and where prices are set well outside of cost effectiveness parameters.
The HSE strives to reach a decision in as timely a manner as possible. However, because these commitments are often multi-million euro investments on an on-going basis, it must ensure that the best price is achieved. This can lead to a protracted negotiation and deliberation process.
My Department and the HSE are working on making greater efficiencies in medicines usage through a range of initiatives both domestically and internationally to ensure the greatest possible access to new treatments for patients in Ireland.
The HSE’s Medicines Management Programme (MMP), incorporating the Preferred Drugs initiative, is overseeing the implementation of a number of actions to bring about greater value for the taxpayer through cost-effective provision of medicines. These measures include the designation of preferred products with a focus on high-cost prescribing areas, in particular optimising the use of biosimilars.
I and officials have also been engaging over the past number of years with a number of voluntary EU forums. In June 2018, I signed the Beneluxa Initiative on Pharmaceutical Policy. This Agreement is in line with my objective to work with other European countries to identify workable solutions, in an increasingly challenging environment, to secure timely access for patients to new medicines in an affordable and sustainable way. In June 2019, Ireland became a Founding Member of the International Horizon Scanning Initiative which is being established as part of the work programme of Beneluxa.
280. Deputy Carol Nolan asked the Minister for Health the action he will take to ensure that the air ambulance service does not close for a period of 16 days or for a period of time in view of the crucial role it plays in saving lives; and if he will make a statement on the matter. [48649/19]
Amharc ar fhreagraThe Emergency Aeromedical Support (EAS) provides rapid access to appropriate treatment for very high acuity patients, specifically where land ambulance transit times would not be clinically appropriate. The service is particularly beneficial for time-dependent cardiovascular patients who constitute about one third of all EAS missions.
EAS services are provided primarily by the Air Corps with reserve capacity provided by the Irish Coast Guard. The service operates seven days a week in daylight hours and is specifically targeted at the West. The highest demand for the EAS comes from Galway, Mayo and Roscommon, and the service has successfully completed over 2,600 emergency missions since it commenced operations in 2012.
The Air Corps is not in a position to accept EAS taskings from the National Ambulance Service for four days per month for a period of four months, from November 2019 to February 2020. During the 16 days when the Air Corps will not accept taskings, the Irish Coast Guard will provide reserve cover for the National Ambulance Service. The Irish Community Rapid Response (ICRR), has agreed to provide additional cover using a second helicopter which will be based in Roscommon Hospital and will be tasked in the usual way, to 112/999 calls by the National Emergency Operations Centre, within the National Ambulance Service. This is in line with current National Ambulance Service priorities whereby the most appropriate and safe services are provided for patients and staff.
This does not affect the current Munster Hems service in the South of Ireland.
281. Deputy Carol Nolan asked the Minister for Health if review of discretionary medical cards will be ceased; if terminally ill patients will be permitted to have automatic entitlement to a medical card; and if he will make a statement on the matter. [48650/19]
Amharc ar fhreagraUnder the provisions of the Health Act 1970 (as amended), eligibility for health services in Ireland is based primarily on residency and means. However, every effort is made by the HSE, within the framework of the legislation, to support applicants in applying for a medical card and, in particular, to take full account of the difficult circumstances in the case of applicants who may be in excess of the income guidelines.
The HSE may exercise discretion and grant a medical card, even though an applicant exceeds the income threshold where they face difficult financial circumstances, such as extra costs arising from an illness. Social and medical issues are also considered when determining whether undue hardship exists for an individual accessing general practitioner or other medical services. There is currently no review underway into the processing of discretionary medical cards.
However regarding emergency medical cards, I announced as part of Budget 2020, that the HSE would undertake a review and extend arrangements regarding the provision of emergency medical cards in cases of terminal illness. A Clinical Advisory Group, established by the HSE, will carry out the review and provide a report on completion.
282. Deputy Eugene Murphy asked the Minister for Health the reason a person (details supplied) was not permitted access and admittance to the psychiatric unit at Roscommon University Hospital on the date specified in view of the nature of the person's condition and the fact that the person posed a danger to the person and others and was accompanied by a member of An Garda Síochána on the date; if the person will be considered for admittance if the person presents at the psychiatric unit; and if he will make a statement on the matter. [48653/19]
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.
283. Deputy Alan Kelly asked the Minister for Health his plans to increase the number of specialist Parkinson's disease nurses nationally in order to have a specialist nurse in each county (details supplied); and if he will make a statement on the matter. [48663/19]
Amharc ar fhreagraThe HSE Model of Care for Neurology, was developed by the HSE’s National Clinical Programme for Neurology in collaboration with consultants, nurses, health and social care professionals and patient support groups. It provides a framework for neurology services, including for Parkinson's Disease patients, using international best practice and describes care provision using an integrated service approach. The model is fully aligned with the objectives of Slaintecare and proposes a hub and spoke model, with services provided as close to home as possible but with access to specialist services where required.
The roles performed by Parkinson’s Disease Nurse Specialists include identifying the patient’s needs and coordinating their care; monitoring symptoms; helping with drug management; and providing emotional and lifestyle support.
In relation to the particular query raised, as this is a service matter, I have asked the HSE to respond to you directly as soon as possible.
284. Deputy Peter Burke asked the Minister for Health when he plans to unwind FEMPI for pharmacists in view of the fact that this process has been initiated for other healthcare professionals; the proposed cuts in pharmacy fees from January 2020; if his Department has reviewed the way in which this will affect the community pharmacy industry especially in rural areas; and if he will make a statement on the matter. [48665/19]
Amharc ar fhreagra334. Deputy Tony McLoughlin asked the Minister for Health if his attention has been drawn to the fact that rural and smaller independent pharmacies will be most affected by the proposed new pharmacy fee scheme; his plans to address same; and if he will make a statement on the matter. [49013/19]
Amharc ar fhreagra335. Deputy Tony McLoughlin asked the Minister for Health the reason for the current proposed changes to the pharmacy fee scheme; his views on whether this is fair and equitable in view of the understanding that most small independent pharmacies look set to be hit by over €35,000 per year as a result; his plans to amend the proposed fee scheme going forward in order that it gives back to the sector; and if he will make a statement on the matter. [49014/19]
Amharc ar fhreagra339. Deputy Niall Collins asked the Minister for Health the status of the unwinding of FEMPI (details supplied); and if he will make a statement on the matter. [49044/19]
Amharc ar fhreagraI propose to take Questions Nos. 284, 334, 335 and 339 together
I recognise the significant role community pharmacists play in the delivery of patient care and the potential for this role to be developed further in the context of health service reform and modernisation.
The regulations governing the current pharmacy fee structure were made under section 9 of the FEMPI Act 2009 and are set to expire at the end of 2019. Under the Public Service Pay and Pensions Act 2017, these regulations must be replaced on 1 January 2020 to maintain a statutory basis for contractor payments and to prescribe the fees payable from that date.
In keeping with my obligations under Section 43 of the 2017 Act, my officials have been undertaking a process of consultation with the IPU, as the representative body, prior to the introduction of new fee regulations. My officials have met with an IPU delegation on two occasions and a detailed submission was received from the IPU on 8 November.
That submission is currently being considered by my Department in the context of the statutory fee-setting process.
In May of this year I addressed the Irish Pharmaceutical Union at the National Pharmacy Conference and gave a commitment to move beyond the arrangements underpinned by the Financial Emergency Measures in the Public Interest Act 2009 (FEMPI) with a view to optimising the role of pharmacists in the years ahead. In that context, it is my intention to open discussions in 2020 on a root and branch review of the current contract. Issues such as those raised by the Deputy will form part of that review.
285. Deputy Robert Troy asked the Minister for Health the status of the care service being provided to a person (details supplied). [48668/19]
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 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.
286. Deputy Eugene Murphy asked the Minister for Health if additional home help support will be provided to a person (details supplied) in view of the person's deteriorating health and advanced years; and if he will make a statement on the matter. [48671/19]
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.
287. Deputy Michael Healy-Rae asked the Minister for Health if equipment will be provided for a person (details supplied); and if he will make a statement on the matter. [48673/19]
Amharc ar fhreagraAs this is a service matter it has been referred to the HSE for direct reply to the Deputy.
288. Deputy Timmy Dooley asked the Minister for Health when a patient (details supplied) in University Hospital Limerick will be transferred to Beaumont Hospital; and if he will make a statement on the matter. [48677/19]
Amharc ar fhreagraAs this is a service issue, it has been referred to the Health Service Executive for attention and direct reply.
289. Deputy Michael Healy-Rae asked the Minister for Health if additional home help hours will be provided for a person (details supplied); and if he will make a statement on the matter. [48684/19]
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.
290. Deputy John Brassil asked the Minister for Health the estimated net cost for 2019 of implementing the nurses’ pay deal agreed in February 2019 based on the savings and productivity measures to be put in place; if the independent verification process to determine the level of savings generated by productivity measures to offset the cost of the deal which was proposed in the Labour Court agreement that led to a resolution of the strike has been put in place; if so, the terms of reference; the details of those who will serve on it; and if the initiatives set out under the agreement will be paused if verified savings and productivity do not materialise by the end of the year in keeping with the recommendation of the Labour Court in dealing with the recent nurses’ pay dispute. [48691/19]
Amharc ar fhreagraImplementation of the agreement reached in relation to nurses and midwives has commenced. Rather than a ‘pay deal’, the agreement is made up of a number of elements intended to improve the recruitment and retention of nurses and midwives.
It provides for the introduction of the Enhanced Practice nurse/midwife roles, as well as a range of other measures. It commits to the continued roll-out of the Framework on Safe Staffing and Skill Mix already underway. The initial focus has been on the introduction of the new enhanced roles. The HSE issued a circular opening the Enhanced Practice role to eligible applicants on 23rd August 2019.
The agreement also includes the recommendations of the Public Service Pay Commission in relation to allowances and accelerated progression for certain nursing and midwifery grades. The HSE has issued a circular giving effect to these allowance increases. The HSE is also continuing to work on the extension of the qualification/location allowance to medical surgical areas. Progress has been made in resolving outstanding issues in relation to psychiatric nurses and the enhanced practice contract and increased allowances will soon be made available to these nurses also.
The HSE has a detailed implementation plan in place and is monitoring the actions set out in this plan.
Labour Court recommendation LCR21900 provides for ‘independent verification mechanism’ to ensure that savings are delivered from this agreement. Consideration is still being given to how such a mechanism would operate and its membership. In the meantime, the agreement, in particular the enhanced practice roles, needs to be given time to have an impact on the health services, before consideration could be given to pausing elements of it.
291. Deputy Denis Naughten asked the Minister for Health when a person (details supplied) will receive an appointment; and if he will make a statement on the matter. [48695/19]
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.
292. Deputy Dara Calleary asked the Minister for Health the substantial recommendations in a study by a company (details supplied) of the medicines reimbursement system; if the recommendations will be published; and if he will make a statement on the matter. [48698/19]
Amharc ar fhreagraWork on the review of the HSE reimbursement and pricing decision-making process is ongoing. The review, conducted by Mazars, is progressing and on completion my officials will consider its findings.
The review will make recommendations, as considered appropriate, in respect of any required improvements to the HSE’s systems, structures, processes, governance arrangements or use of specialist resources in respect of the review.
293. Deputy Niamh Smyth asked the Minister for Health the reason a person (details supplied) is not being called for a MRI scan; the reason the person was provided with false information; and if he will make a statement on the matter. [48699/19]
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.
294. Deputy Willie O'Dea asked the Minister for Health the reason for the long waiting list for children who wear orthotics; if there is a problem with funding for same in mid-western areas; and if he will make a statement on the matter. [48700/19]
Amharc ar fhreagraAs this is a service matter it has been referred to the HSE for direct reply to the Deputy.
295. Deputy Peter Burke asked the Minister for Health if a person (details supplied) is eligible for a long-term illness card. [48705/19]
Amharc ar fhreagraThe LTI Scheme was established under Section 59(3) of the Health Act 1970 (as amended). The conditions covered by the LTI are: acute leukaemia; mental handicap; cerebral palsy; mental illness (in a person under 16); cystic fibrosis; multiple sclerosis; diabetes insipidus; muscular dystrophies; diabetes mellitus; parkinsonism; epilepsy; phenylketonuria; haemophilia; spina bifida; hydrocephalus; and conditions arising from the use of Thalidomide. Under the LTI Scheme, patients receive drugs, medicines, and medical and surgical appliances directly related to the treatment of their illness, free of charge.
Regulations were made in 1971, 1973 and 1975 specifying the conditions covered by the LTI Scheme, including mental illness in a person under 16 years of age.
There are no plans to extend the list of conditions covered by the Scheme or the age limit in relation to mental illness at this time. However, I wish to inform the Deputy that it is proposed that the LTI Scheme would be included as part of a review of the basis for existing hospital and medication charges, to be carried out under commitments given in the Sláintecare Implementation Strategy.
296. Deputy Niamh Smyth asked the Minister for Health the reason children (details supplied) cannot obtain an appointment for speech, occupational and physiotherapy, respectively; and if he will make a statement on the matter. [48707/19]
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 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.
297. Deputy Thomas Byrne asked the Minister for Health the terms and conditions for a person who is entitled to respite care. [48711/19]
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.
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 service matters, I have arranged for the question to be referred to the Health Service Executive (HSE) for direct reply to the Deputy.
298. Deputy Peter Burke asked the Minister for Health the status of a project (details supplied); and if he will make a statement on the matter. [48713/19]
Amharc ar fhreagraAs the Health Service Executive is responsible for the delivery of public healthcare infrastructure projects, I have asked the HSE to respond to you directly in relation to this matter.
299. Deputy Robert Troy asked the Minister for Health if a person (details supplied) is on the waiting list for cataract surgery in the Royal Victoria Eye and Ear Hospital, Dublin. [48728/19]
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.
300. Deputy Tony McLoughlin asked the Minister for Health his views on whether pharmacies are best placed to help reduce the burden on general practitioners and accident and emergency departments nationwide (details supplied); his further views on whether such schemes and services could have multiple benefits for the HSE and further support smaller and independent pharmacies financially in the event that the proposed cuts in the current draft of the new pharmacy contract are not removed; and if he will make a statement on the matter. [48738/19]
Amharc ar fhreagraI value the role pharmacists play in the Irish health service. As you are aware, the Programme for a Partnership Government and the Sláintecare implementation strategy contain commitments to expanding the role of community pharmacy in managing patient health in the community.
Work has been done in recent years on wider healthcare roles for pharmacies, including the Pharmaceutical Society of Ireland’s Future Pharmacy report, on the expansion of professional pharmacy practice. It is clear from this and other work that there is potential to increase the range of both private and publicly funded health services delivered through community pharmacy. Important new services, such as influenza vaccination and emergency contraception, have already been introduced.
To be funded by the taxpayer, new public health services in community pharmacy, as elsewhere, should improve health outcomes and provide value for money and benefits for patients. Any new or transferred services should be based on sound evidence, with matching improvements in governance and administration.
I have discussed these and other issues with the Irish Pharmacy Union (IPU). My officials expect to engage in discussions with the IPU on future contractual and service arrangements early in the New Year.
301. Deputy Denis Naughten asked the Minister for Health the number of NTPF appointments provided to ENT patients to date in 2019; the effect this has had on individual hospital waiting lists; his plans to address such waiting lists in 2020; and if he will make a statement on the matter. [48739/19]
Amharc ar fhreagraReducing waiting time for patients for hospital operations and procedures is a key priority for Government. In this regard, the Government is committed to improving waiting times for hospital appointments and procedures.
The National Treatment Purchase Fund (NTPF) supply additionality to HSE core activity in order to reduce waiting times experienced by patients for a hospital appointment, operation or procedure. In this context, the NTPF has advised my Department that they have approved a number of Outpatient proposals for ENT in 2019, which to date has provided over 4,400 patient appointments.
The latest National Treatment Purchase Fund figures show that there are 65,696 patients on the ENT Outpatient waiting list. Of these, 53% (34,507) are waiting 12 months or less. Overall, the ENT Outpatient waiting list has decreased by 0.6% (-383) when compared to the same period last year.
The figures for October also show that there are 4,401 patients on the ENT IPDC waiting list. Of these, 63% (2,759) are waiting 6 months or less, 75% (3,286) are waiting 9 months or less and 82% (3,608) are waiting 12 months or less. Overall, the ENT IPDC waiting list has decreased by 18% (-971) when compared to the same period last year.
More broadly, Budget 2020 announced that the Government has further increased investment in tackling waiting lists, with funding to the NTPF increasing from €75 million in 2019 to €100 million in 2020.
My Department is working with the HSE and National Treatment Purchase Fund to develop the Scheduled Care Access Plan 2020. The National Service Plan 2020 will set out HSE planned activity level for the year ahead, while the NTPF will work with the hospital system to provide additionality to improve access to inpatient/daycase treatment and with a particular focus on hospital outpatient services.
In this regard, I would encourage all hospital groups and individual hospitals to engage with the NTPF to identify waiting list proposals for the remainder of this year and for 2020.
302. Deputy Michael Healy-Rae asked the Minister for Health if he will address a matter regarding the case of a person (details supplied); and if he will make a statement on the matter. [48746/19]
Amharc ar fhreagraAs this question relates to service matters, I have arranged for the question to be referred to the Health Service Executive (HSE) for direct reply.
303. Deputy Mary Lou McDonald asked the Minister for Health the future plans of the HSE for a location (details supplied). [48753/19]
Amharc ar fhreagraDublin Simon Community has operated a Residential Recovery Service at Ushers Island since 2003 for people who are homeless. It is understood that they plan to develop Ushers Island to provide a purpose-built centre incorporating a range of existing and new services.
It is intended that the service provided at the Ushers island facility will re-locate to new premises while it undergoes the necessary reconstruction. My Department understands that the location referred to by the Deputy will continue to be used as residential long term housing for people who are experiencing homelessness. That location will not host any relocated services. Once the development at Ushers Island is completed it is anticipated that the Recovery service will return fully to that location.
As this is a service matter it has been referred to the HSE for attention and direct reply to the Deputy.
